Facial Soft Tissue Changes Following Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea

Prospective assessment of maxillary advancement effects: Maxillary incisor exposure, and upper lip and nasal changes

“…The range of the mean horizontal soft to hard tissue ratios from pronasale to stomion superius found in many studies [4][5][6][7][11][12][13][14][15][16][17] (pronasale, 0.24-0.35; subnasale, 0.26-0.64; labrale superius, 0.36-1.43; stomion superius, 0.31-1.43) reflects a pattern where soft tissues from pronasale to labrale superius increasingly follow more closely the hard tissue movement, with labrale superius and stomion superius moving at similar ratios. 18 Vertical ratios of soft to hard tissue movement are less well documented and demonstrate greater variability among studies.…”

“…These ratios showed ranges of 0.28 to 0.52 at pronasale, 0.54 to 0.63 at subnasale, and 0.33 to 0.96 at labrale superius relative to maxillary incisor movement. 11,17 In general, the upper lip soft tissue moves by 25% to 50% of the maxillary vertical movement. 12 Several potential variables may affect the ratio of soft to hard tissue movement after a LeFort I osteotomy: patient factors (sex, age), ethnicity, 19 amount and direction of surgical movement, 6 and lip thickness.…”

Surgical treatment of the sleep apnea Syndrome

“…Many investigators have evaluated secondary facial modifications 4,6,15 . None have reported unsatisfactory results that led patients to regret having had this treatment procedure.…”

Surgical treatment modality for facial esthetics in an obstructive sleep apnea patient with protrusive upper lip and acute nasolabial angle

“…Generally, whites have a convex facial profile, retroclined maxillary incisors, and an obtuse nasolabial angle, which suggest that both the maxilla and mandible are in a retrognathic position. Conley and Boyd 15 reported that MMA decreased the nasolabial angle and that the ratio of soft tissue to hard tissue was about 0.9:1 for the upper lip, lower lip, and chin. Therefore, MMA in white patients with OSAS can improve the soft-tissue support and result in rejuvenation of the middle and lower third of the face.…”

“…To the authors' knowledge, only a few studies have been published regarding facial esthetics for surgical planning in OSAS. 14,15 The purposes of this case report were to evaluate the effect of surgery to achieve total impaction of the maxilla, autorotation/advancement of the mandible, and advancement of the chin (IMX-AAMN-AC) on a patient with OSAS using polysomnogram, 2D-cephalometric, and 3D-CT analyses, and to suggest a customized flowchart for surgical treatment planning for OSAS that considers facial esthetics.…”