3차원 CT 영상을 이용한 정상교합자의 안면 연조직 계측 분석

유형석,한수연,백형선,김기덕 대한치과교정학회 발행 2005 대한치과교정학회지 Vol.35 No.6

최근 들어 3차원 전산화 단층 촬영(CT, Computed Tomography) 영상을 이용한 진단기법의 개발을 위한 연구가 활발히 진행되고 있으며 여러 분야에서 3차원적인 두개악안면 분석의 필요성이 증대되고 있다. 특히 교정 치료나 악교정 수술 후의 결과에 있어서 안면 연조직의 분석은 필수적이라 할 것이다. 본 연구에서는 정상교합을 가진 성인 남자 12명, 성인 여자 11명의 CT 영상을 촬영하여 개인용 컴퓨터 상에서 V works 4.0 프로그램 (Cybermed Inc., Seoul, Korea)으로 3차원 CT 연조직 영상을 재구성한 후에 soft tissue Nasion을 기준 원점으로 하는 3차원 좌표평면의 좌표계를 설정하여 정중선상의 soft tissue Nasion, Pronasale, Subnasale, Upper lip center, Lower lip center, soft tissue B, soft tissue Pogonion, soft tissue Menton 등 8개의 계측점과 양측성인 Endocanthion, Alare lateralis, Cheilion, soft tissue Gonion, Tragus, Zygomatic point 등 총 20개의 재현 가능한 안면 연조직의 계측점을 지정하였으며 V surgery 프로그램(Cybermed Inc., Seoul, Korea)을 이용하여 이들 계측점의 3차원적인 좌표와 기준 원점으로부터 각 계측점까지의 Net (δ=√ (X^(2)+Y^(2)+z^(2))) 값의 평균과 표준편차를 구하였다. 안면 연조직 분석의 3차원적인 이해를 돕기 위해 주요 계측점 간의 거리 계측을 시행하였고, 그 결과 Na'-Sn과 En(Rt)-En(Lt)를 제외한 대부분의 계측값에서 남녀간의 유의한 차이가 있었으며, 2차원적인 두부 방사선 규격사진이나 안면 사진으로는 정확한 계측이 어려웠던 Na'-Zy, Na'-Ch, Na'-Go' (facial depth) 등의 정상치도 구하였다. 이상의 자료는 부정교합 환자와 악안면 기형 환자의 3차원적인 진단 및 치료 계획에 참고자료로 사용될 수 있을 것이다. Studies for diagnostic analysis using three-dimensional (3D) CT images are recently in progress and needs for 3D craniofacial analysis are increasing in the fields of orthodontlcs. It is especially essential to analyze the facial soft tissue after orthodontic treatment and orthognathic surgery. In this study 3D CT images of adults with normal occlusion were taken to analyze. the facial soft tissue. Norms were obtained from CT images of adults with normal occlusion (12males, 11 females) using a computer program named V works 4.0 program. 3D coordinate planes were established using soft tissue Nasion as the reference point and a total of 20 reproducible landmarks of facial soft tissue were obtained using the multiple reconstructive sectional images (axial, sagittal and coronal images) of the V works 4.0 program: soft tissue Nasion, Pronasale, Subnasale, Upper lip center, Lower lip center, soft tissue B, soft tissue Pogonion, soft tissue Menton, Endocanthion (Rt/Lt), Alare lateralis (Rt/Lt), Cheilion (Rt/Lt), soft tissue Gonion (Rt/Lt), Tragus (Rt/Lt), and Zygomatic point (Rt/Lt). According to the established landmarks and measuring method, the 3D CT images of adults with normal occlusion were measured and the normal positional measurements and their Net (δ=√ (X^(2)+Y^(2)+z^(2))) values were obtained using V surgery program. In the linear measurement between landmarks, there was a significant difference between males and females except Na'-Sn and En(Rt)-En(Lt). The normal ranges of Na'-Zy, Na'-Ch and Na'-Go' (facial depth) were obtained. which was difficult to measure by two-dimensional (2D) cephalometric analysis and facial photographs. These data may be used as references for 3D diagnosis and treatment planning for patients with malocclusion and dentofacial deformity.

3차원 레이저 스캔을 이용한 안면 연조직 분석을 위한 계측점의 제안

백형선,이화진,전재민 대한치과교정학회 2006 대한치과교정학회지 Vol.36 No.1

3차원 레이저 스캐너는 두개안면부의 입체적인 영상을 구성할 수 있을 뿐만 아니라 컴퓨터의 조작을 통해 관찰이 용이하도록 원하는 위치로 회전과 축의 조정이 가능하여 면밀한 연조직 분석이 가능하다. 이에 본 연구에서는 Vivid 900 (Minolta, Tokyo, Japan) 3차원 레이저 스캐너와 Rapidform 프로그램 (Inus Technology Inc., Seoul, Korea)을 이용하여 마네킨의 3차원 영상을 채득하여 촬영 과정의 오차를 평가하고 3차원 레이저 스캔 영상의 정밀도 및 확대율을 평가하였으며, 마네킨과 정상교합자, 제Ⅱ급 부정교합자, 제 Ⅲ급 부정교합자의 3차원 레이저 스캔 영상에서 지정이 용이하고 반복 재현성이 높은 연조직 계측점을 제안하고자 하였다. 마네킨을 6회 반복 촬영한 결과 촬영 과정에서의 평균 오차는 X축은 0.16mm, Y축은 0.15mm, Z축은 0.15mm였다. 마네킨의 실측치와 3차원 스캔 영상에서의 계측치를 비교하여 본 결과, 평균오차 0.37mm, 확대율 0.66%로 나타났다. 3차원 스캔 영상에서 마네킨의 오른쪽 연조직 gonion을 제외한 26개의 연조직 계측점의 평균 오차가 2.0mm를 넘지 않았으며, glabella, 연조직 nasion, endocanthion, exocanthion, pronasale, subnasale, nasal alare, upper lip point, cheilion, lower lip point, 연조직 B point, 연조직 pogonion, 연조직 menton, preaurale 등이 평균 오차가 적었다. 제안된 연조직 계측점들은 3차원 레이저 영상에서 반복 재현성이 높고 지정이 용이하며 안면의 해부학적 특징을 나타내주는 점들로 두개안면 구조의 3차원적인 연조직의 분석을 위해 유용하게 사용될 수 있을 것이다. Three-dimensional (3-D) laser scans can provide a 3-D image of the face and it is efficient in examining specific structures of the craniofacial soft tissue. Due to the increasing concerns with the soft tissues and expansion of the treatment range, a need for 3-D soft tissue analysis has become urgent. Therefore, the purpose of this study was to evaluate the scanning error of the Vivid 900 (Minolta, Tokyo, Japan) 3-D laser scanner and Rapidform program (Inus Technology Inc., Seoul, Korea) and to evaluate the mean error and the magnification percentage of the image obtained from 3-D laser scans. in addition, soft tissue landmarks that are easy to designate and reproduce in 3-D images of normal, Class Ⅱ and Class Ⅲ maloccusion patients were obtained. The conclusions are as follows; scanning errors of the Vivid 900 3-D laser scanner using a manikin were 16mm in X axis, 0.15mm in the Y axis, and 0.15mm in the Z axis. In the comparison of actual measurements from the manikin and the 3-D image obtained from the Rapidform program, the mean error was 0.37mm and the magnification was 0.66%. Except for the right soft tissue gonion from 3-D image, errors of all soft tissue landmarks were within 2.0mm. Glabella, soft tissue nasion, endocanthion, exocanthion, pronasale, subnasale, nasal alare, upper lip point, cheilion, lower lip point, soft tissue B point, soft tissue pogonion, soft tissue menton and preaurale had especially small errors. Therefore, the Rapidform program can be considered a clinically efficient tool to produce and measure 3-D images. The soft tissue landmarks proposed above are mostly anatomically important points which are also easily reproducible. These landmarks can be beneficial in 3-D diagnosis and analysis.

외측 상박부 유리 근막 피판을 이용한 사지 연부 조직 결손부의 피복

김승홍,박정준,곽혁준,최병욱,민대홍 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.4

Traumatic injury to the hand or foot often leads to extensive skin and soft tissue loss, exposing the blood vessels, nerves, tendons or bones. Therapeutic options for salvaging these soft tissue defects include local, regional or distant flaps and free flap transplantation. Over the last two decades, the use of free tissue transfer has gained increasing popularity in reconstruction of soft tissues defect. Reconstruction of soft tissue defects with exposure of bone, tendon or other vital structures on the hands and feet can be a challenging problem, especially open wounds on dorsum of the foot and hand. The main purposes of resurfacing of the soft tissue defects are early coverage and mobilization of the defects to cover the exposed vital structures and to prevent further deformity. In hand and foot dorsum resurfacing, the fascia is the most ideal donor flaps in terms of thin, pliable and well vascularized sheets of tissue. It leaves an inconspicuous donor site morbidity. In addition, microvascular transfer is facilitated the axial pattern flap with consist, reliable vascular pedicles. The flap is useful in covering exposed bone and tendon without unwanted bulk, in providing an ultrathin flap coverage in soft tissue defects, and it provides a good intrinsic blood supply to improve local conditions for healing and to decrease bacterial contamination of the wound. It can also establish a fine tendon-gliding mechanism. We have experienced 8 cases of resurfacing of full thickness skin and soft tissue loss in the hand and foot dorsum defects with lateral arm fascia free flap. We achieved successfully soft tissue coverage with minimal complications. The largest size of the flap had 13.5×9cm in dimesion. We could gain satisfactory results of soft tissue coverage with ultrathin arterialized pedicale flap and now we report our clinical experience of lateral arm fascia free flap.

연조직고형종양의 악성과 양성 감별: 임상과 자기공명영상 복합소견

문태용,김정일,신수미,추혜정,최현욱,김수진,Moon, Tae-Yong,Kim, Jung-Il,Shin, Su-Mi,Choo, Hye-Jeung,Choi, Hyun-Wook,Kim, Soo-Jin 대한근골격종양학회 2004 대한골관절종양학회지 Vol.10 No.2

목적: 최근 자기공명영상의 개발로 다양한 연조직종양의 영상의학적 진단이 가능해 졌다. 그러나 연조직종양의 다양한 조직구성이나 시간에 따라 구성분의 변화는 자기공명영상 만으로 악성과 양성 종양조차 감별을 어렵게 한다. 이에 본 저자들은 임상과 자기공명영상의 복합적인 소견으로 악성과 양성 연조직종양을 감별해 보고자 하였다. 대상 및 방법: 병리조직학적으로 확진된 82례(중간성종양을 악성종양으로 포함하여 37례와 염증성 종괴를 양성종양으로 포함하여 45례)를 후향적으로, 임상적 소견으로 연령, 크기, 위치, 그리고 자기공명영상 소견으로 종양경계, T2신호강도양상, 조영제T1신호강도양상, 그리고 조영증강 범위를 연관시켜 분석하였다. 자기공명영상으로 진단이 어렵지 않는 많은 전형적인 지방종과 결절종 그리고 농양같은 낭종은 양성종양 분류에서 제외하였다. 결과: 악성연조직종양은 양성에 비하여 연령으로 21~40세와 61~80세, 크기로 3.0 cm 이상, 발생위치로 몸체-골반-하지, 그리고 자기공명영상에서 불규칙한 경계, 50%이상의 조영증강범위 소견들의 빈도가 높았다. 결론: 발생위치로 몸체-골반-하지 와 상지-어깨-척추 로 나눈 임상소견이 악성과 양성 연조직종양을 감별하는데 통계학적으로 유의성있는 차이를 보였으며 나머지 다른 소견들은 특이적이지는 않았지만 부가적으로 악성과 양성을 감별하는데 도움이 되는 소견이었다. Purpose: The recent development of MR has made to possible radiological diagnosis in various soft tssue tumors. But multifarious components within soft tissue tumors and their periodic change have made to difficult even differentiation of malignant from benign soft tissue tumors solely on the MR. So authors retry to differentiate malignant from benign soft tissue tumors with clinical and MR finding complex. Materials and methods: We were analysed 82 pathologically confirmed soft tissue solid tumors (37 cases as malignancy including intermediate tumors and 45 cases as benign including inflammatory masses) which are correlated with clinical findings such as age, size, and location, MR findings such as tumor border, texture on T2 and contrast-T1 images, and enhancement area retrospectively. Many typical lipoma and cysts including of ganglion and abscess are rejected in the benign soft tissue tumor group because not difficult to diagnose on MR. Results: Malignant soft tissue tumors were more frequent in 21~40 and 61~80 years old of the age, above 3.0 cm of the size, trunk-pelvis-lower extremities of the location, and MR findings with irregular border and above 50% of the enhancement area than those of benign soft tissue tumors. Conclusion: The clinical finding that divided to two locations as trunk-pelvis-lower extremities and upper extremities-shoulder-spine was statistically significant to differentiate malignant from benign soft tissue solid tumors. However, the others would provide some useful informations to differentiate them never specific.

골격성 III급 부정교합자의 체질량지수에 따른 술후 연조직 변화

김은철,이상철,Kim, Eun-Cheol,Lee, Sang-Chull 대한악안면성형재건외과학회 1999 Maxillofacial Plastic Reconstructive Surgery Vol.21 No.3

This study has been carried out in order to measure the thickness of soft-tissue on lateral cephalographs based on body mass index(BMI) and the change in soft-tissue thickness after surgical correction of mandibular protrusion. The control material in cephalometric study comprised students at The Dental College, 38 persons, aged 21~24 years and the patient material comprised 20 women and 12men, aged 19~28 years with mandibular protrusion.The thickness of the soft-tissue based on BMI in control and study groups, the comparison between them, immediate postoperative change in the thickness, 6 months after surgery, ratio of soft-tissue response and correlation was established through various statistical methods. The result were as follows : 1. The groups based on BMI showed significant differences each other as regards the linear measurements. The thickest soft-tissue was measured 13.6mm, 15.47mm, 16.76mm at Ss, the thinnest at G' 6.0mm, 6.7mm, 7.26mm respectively. 2. The differences between control and experimental groups based on BMI showed to be significant. There were no differences at G'. The soft-tissue in prognathic patients was thicker at Ss, Ls and thinner at Li, Ls, Pg', Gn', Me'. Differential gap was greater in overweight groups. 3. The immediate soft-tissue change after surgery showed the increase at Li, Ls, Pg', Gn', Me' except G', Ls in all groups. 4. The postoperative soft-tissue change 6 months after surgery was similar with immediate change. The soft-tissue shows the increase in the thickness at Li, Pg', Gn', Me' and the greatest difference occurred at Li, 1.1mm, 0.98mm, 1.2mm respectively. 5. The patients with lower BMI index showed higher soft-tissue response to bony movement at Pg'. The immediate response ratio was 91%, 87%, 81% in A,B,C groups respectively, the response 6 months after surgery showed 96%, 91%, 84%.

Evaluation of facial soft tissue thickness in asymmetric mandibular deformities after orthognathic surgery

Luo Huang,Zhicong Li,Jing Yan,Lunqiu Chen,Zhengguo Piao 대한악안면성형재건외과학회 2021 Maxillofacial Plastic Reconstructive Surgery Vol.43 No.-

Objectives: The purpose of this study was to compare differences in facial soft tissue thickness in three-dimensional(3D) images before and after orthognathic surgery in patients with skeletal Class III malocclusion and to obtain a betterunderstanding of the relationship between hard and soft tissue changes after surgery. Materials and method: The present retrospective study included 31 patients with skeletal Class III malocclusion withmandibular chin deviation greater than 4 mm who had undergone cone-beam computed tomography before and 6months after surgery. Seven bilateral points were established. Measurements were taken from software-generatedmultiplanar reconstructions. The predictor variables were timing (pre- and postoperatively) and side (deviated vs. nondedicated). A regression model and correlation analysis were conducted for statistical analysis. Results: The difference of bilateral facial soft tissue thickness was statistically significantly different between deviatedand nondeviated sides (P < 0.05), with lower values observed on the deviated side. The soft tissue thickness hasbecome nearly symmetric at local regions of the lower thirds of the face after orthognathic surgery. However, mostmeasurements showed a negative correlation between changes in soft tissue thickness and changes in bone tissues. Conclusions: Skeletal Class III malocclusion with facial asymmetry is accompanied by differences in soft tissuethickness when comparing Dev and N-Dev sides of the posterior region of the mandible, where soft tissues are thinneron the Dev side. Soft tissue thickness can compensate for or camouflage the underlying asymmetric mandible. Inaddition, the asymmetric soft tissue thickness on the lower third of the face can be partially improved by orthognathicsurgery, but the amount of soft tissue thickness change is not consistent with that of hard tissue positional change.

안면비대칭자의 3차원 전산단층사진 분석에서 경·연조직간 비대칭 정도 차이

김왕식,이기헌,황현식 대한치과교정학회 2005 대한치과교정학회지 Vol.35 No.3

본 연구는 안면비대칭 환자에서 경조직의 비대칭 정도와 연조직 비대칭 정도의 차이를 3차원적으로 밝히고자 시행되었다. 안면비대칭으로 보이는 성인 남녀 34명을 대상으로 두경부 전산단층사진을 촬영하고 3차원 입체영상으로 재구성한 후 기준평면에 대해 비대칭을 나타내는 6개의 계측항목을 경조직에 설정하고, 이에 대응하는 연조직계측항목을 각각 설정한 후 3차원 계측을 시행하고 경조직과 연조직의 계측항목간 차이를 비교하였다. 이부편위측과 반대측간의 계측치 차이를 비교한 결과, 경조직과 연조직 모두에서 좌우측 계측치관에 통계적으로 유의한 차이가 관찰되었으며 경조직과 연조직의 비대칭 계측항목을 비교한 결과. 0개의 계측항목 모두에서 통계적으로 유의한 차이를 나타내었다. 이부편위를 나타내는 chin deviation, 하악지와 하악골체를 나타내는 frontal ramal inclination difference. frontal corpus inclination difference 항목은 경조직의 비대칭 정도에 비하여 연조직 비대칭정도가 작게 나타난 반면, 입술경사를 나타내는 lip cheilion height difference. lip canting은 maxillary height difference, occlusal plane canting보다 크게 나타나 입술부위의 비대칭 정도는 하부 경조직의 비대칭정도보다 큰 것으로 나타났다. 안면비대칭자에서 경조직과 연조직간 비대칭 정도 차이를 규명한 본 연구 결과는안면비대칭 평가 시 경조직 외에 연조직 계측항목을 이용한 비대칭 분석도 필요함을 시사하였다. The purpose of this study was to compare the asymmetric degree between maxillofacial hard and soft tissues in individuals with facial asymmetry. Computerized tomographies (CT) of 34 adults (17 male, 17 female) who had facial asymmetry were taken. The CT images were transmitted to personal computers and then reconstructed into three-dimensional (3D) images through the use of computer software. In order to evaluate the degree of facial asymmetry, 6 measurements were constructed as the hard tissue measurements while 6 counterpart measurements were taken as the soft tissue measurements. The means and standard deviations were obtained for each measurement using 3D measure, then t-test was used to investigate the differences between each hard tissue measurement and the corresponding soft tissue measurement. All measurements used in the present study showed statistically significant differences between the hard and soft tissues. The degree of soft tissue asymmetry was smaller than that of corresponding hard tissue asymmetry in case of chin deviation, frontal ramal inclination difference, and frontal corpus inclination difference. On the other hand, the degree of soft tissue asymmetry was greater than that of underlying hard tissue asymmetry in the measurement of lip canting and lip cheilion height difference. The present study suggests that asymmetric differences of hard and soft tissue is observed in facial asymmetric subjects, and thus soft tissue analysis is needed in addition to hard tissue analysis when making an evaluation of facial asymmetry.

Soft-tissue thickness of South Korean adults with normal facial profiles

차경석 대한치과교정학회 2013 대한치과교정학회지 Vol.43 No.4

Objective: To standardize the facial soft-tissue characteristics of South Korean adults according to gender by measuring the soft-tissue thickness of young men and women with normal facial profiles by using three-dimensional (3D) reconstructed models. Methods: Computed tomographic images of 22 men aged 20 - 27 years and 18 women aged 20 - 26 years with normal facial profiles were obtained. The hard and soft tissues were three-dimensionally reconstructed by using Mimics software. The soft-tissue thickness was measured from the underlying bony surface at bilateral (frontal eminence, supraorbital, suborbital, inferior malar, lateral orbit, zygomatic arch, supraglenoid, gonion, supraM2, occlusal line, and subM2) and midline (supraglabella, glabella, nasion, rhinion, mid-philtrum, supradentale, infradentale, supramentale, mental eminence, and menton) landmarks. Results: The men showed significantly thicker soft tissue at the supraglabella, nasion, rhinion, mid-philtrum, supradentale, and supraglenoid points. In the women, the soft tissue was significantly thicker at the lateral orbit, inferior malar, and gonion points. Conclusions: The soft-tissue thickness in different facial areas varies according to gender. Orthodontists should use a different therapeutic approach for each gender.

Effect of Dry Strength Agent on Tissue Properties

( Melani Lili ),김형진 한국공업화학회 2018 한국공업화학회 연구논문 초록집 Vol.2018 No.0

Main properties of tissue paper are absorbency, strength, and softness. Softness can’t be easily quantified to other paper properties such as strength and absorption. Softness can be categorized as bulk and surface softness, bulk softness is the perception when crumpling tissue by hand while surface softness is perception when finger running over the surface of tissue paper. It is reported that softness is a balance between surface smoothness, bulk, and stiffness. Dry strength is a physical property determined by a paper’s ability to maintain the paper web structure and integrity while being used. A sheet’s dry strength is mainly due to fiber-to fiber bonding which typically hydrogen bonding. In this study, dry strength agent was added to pulp stock for manufacturing tissue by different concentration. Furthermore, tissue properties was evaluated based on addition of dry strength agent.

Soft-tissue thickness of South Korean adults with normal facial profiles

Cha, Kyung-Suk The Korean Association Of Orthodontists 2013 대한치과교정학회지 Vol.43 No.4

Objective: To standardize the facial soft-tissue characteristics of South Korean adults according to gender by measuring the soft-tissue thickness of young men and women with normal facial profiles by using three-dimensional (3D) reconstructed models. Methods: Computed tomographic images of 22 men aged 20 - 27 years and 18 women aged 20 - 26 years with normal facial profiles were obtained. The hard and soft tissues were three-dimensionally reconstructed by using Mimics software. The soft-tissue thickness was measured from the underlying bony surface at bilateral (frontal eminence, supraorbital, suborbital, inferior malar, lateral orbit, zygomatic arch, supraglenoid, gonion, supraM2, occlusal line, and subM2) and midline (supraglabella, glabella, nasion, rhinion, mid-philtrum, supradentale, infradentale, supramentale, mental eminence, and menton) landmarks. Results: The men showed significantly thicker soft tissue at the supraglabella, nasion, rhinion, mid-philtrum, supradentale, and supraglenoid points. In the women, the soft tissue was significantly thicker at the lateral orbit, inferior malar, and gonion points. Conclusions: The soft-tissue thickness in different facial areas varies according to gender. Orthodontists should use a different therapeutic approach for each gender.