Influence of maxillary advancement surgery on skeletal and soft-tissue changes in the nose — a retrospective cone-beam computed tomography study

Abstract

ObjectivesSurgical correction of skeletal maxillary retroposition is often associated with changes in the morphology of the nose. Unwanted alar flaring of the nose is observed in many cases. The aim of the present study was therefore to investigate the influence of surgical advancement of the maxilla on changes in the soft-tissue morphology of the nose. Having a coefficient that allows prediction of change in the nasal width in Caucasian patients after surgery would be helpful for treatment planning.Materials and methodsAll 33 patients included in this retrospective study were of Caucasian descent and had skeletal Class III with maxillary retrognathia. They were all treated with maxillary advancement using a combination of orthodontic and maxillofacial surgery methods. Two cone-beam computed tomography (CBCT) datasets were available for all of the study's participants (16 female, 17 male; age 24.3 ± 10.4 years): the first CBCT imaging was obtained before the planned procedure (T0) and the second 14.1 ± 6.4 months postoperatively (T1). Morphological changes were recorded three-dimensionally using computer-aided methods (Mimics (Materialise NV, Leuven/Belgium), Geomagic (Geomagics, Morrisville/USA)). Statistical analysis was carried out using SPSS 21 for Mac.ResultsThe mean sagittal advancement of the maxilla was 5.58 mm. The width of the nose at the alar base (Alb) changed by a mean of + 2.59 mm (±1.26 mm) and at the ala (Al) by a mean of + 3.17 mm (±1.32 mm). Both of these changes were statistically highly significant (P = 0.000). The increase in the width of the nose corresponded to approximately half of the maxillary advancement distance in over 80 % of the patients. The nasolabial angle declined by an average of −6.65° (±7.71°).ConclusionsMaxillary advancement correlates with a distinct morphological change in nasal width. This should be taken into account in the treatment approach and in the information provided to patients.

Evaluation of Soft Tissue Changes in the Nasolabial and Mental Region After Class Iii Orthognathic Surgery: Systematic Review

“…A forward projection of the nasal tip regardless of the type of intervention performed was reported in almost all the studies except for the study by junho et al, [22] which found less displacement of the nasal tip after bimaxillary or advanced maxillary surgery, thanks to the suturing of the wing strap considered to prevent or reduce the effect of its inevitable postoperative enlargement, which led to a kind of reduction in the projection of the nasal tip.…”

“…Most of the studies included in this synthesis showed an increase in alar base width [16,17,22], which was statically significant after advanced jaw surgery, while an increase in the nasolabial angle was found in 3 studies [13,16,18], related to bimaxillary surgery, which was mainly related to the increase in distance (ENA-GN). While a decrease in the nasolabial angle was reported in 3 articles but remains non-statically significant, which is correlated with nasal morphology which differs according to the ethnic origin of patients.…”

“…While a decrease in the nasolabial angle was reported in 3 articles but remains non-statically significant, which is correlated with nasal morphology which differs according to the ethnic origin of patients. [14,17,22].…”

“…The initial shape of the nose and the degree of jaw advancement must be taken into account when planning the operation. [22,24] We recommend that particular attention be paid to patients with unfavorable preoperative nasolabial parameters.…”

Three-dimensional Analysis of Nasolabial Soft Tissues While Smiling Using stereophotogrammetry (3dMDTM)

“…The nasolabial region is the central esthetic unit of the face and is considered one of the most important determinants of the facial esthetic (Jang et al, 2017). In order to obtain a good functional, esthetic and predictable outcome, it is crucial that the surgical effects on the soft and hard tissues be understood (Hellak et al, 2015). Pre-surgical planning focuses on the initial stability of the facial tissues, so the static condition is one of the parameters included, whereas the dynamic position of facial tissues can bring about changes in the results of facial proportion and normality.…”