Lip-Nasal Aesthetics Following Le Fort I Osteotomy

Objective: To determine the changes in the position and area of nasal and labial soft tissues in adult skeletal Class III patients who underwent bimaxillary orthognathic surgery. Materials and Methods: Pretreatment (T1), preoperative (T2), and posttreatment (T3) cephalometric variables and upper-lower lip areas were measured on lateral cephalometric radiographs for 20 individuals (9 male, 11 female; mean age 21.3 years at T1, 22.4 years at T2, and 23.4 years at T3) who had maxillary advancement and mandibular setback. Analysis of variance (AN-OVA) and Duncan tests were used to compare the cephalometric and area measurements at the beginning of treatment, and at presurgery and postsurgery, respectively. Paired t-tests were also performed to analyze changes within the periods. Results: The tip of the nose was affected less with the movement of the underlying skeletal structure (0.25%), while the soft tissue B point (BЈ) moved equally with the skeletal B point. As the maxilla related variables increased due to the forward movement, the upper labial areas decreased. With the backward movement of the mandible, the middle and inferior lower labial areas increased, while the superior lower labial area decreased. Conclusions:The results of our study suggest that the dramatic improvement in the facial profiles of the bimaxillary surgery patients is primarily related to the backward movement of the mandible and the significant reduction in the superior lower lip area.

Section: Posposilsupporting

confidence: 92%

Facial Soft Tissue Profile Following Bimaxillary Orthognathic Surgery

Altuğ

Bolatoglu

Memikoğlu

2008

“…Investigations [6][7][8][9][10] of the soft tissue response after isolated maxillary advancement have reported a wide range of ratios (0.3:1 to 0.9:1) for upper lip change to maxillary movement with weak correlations. Factors that have been suggested to contribute to the unpredictable response of the upper lip are a ''dead space'' (lip-block) between a retrognathic maxilla and the upper lip 8 and adjunctive soft tissue procedures such as V-Y closure of the upper lip suture 11 and alar base cinch suture.…”

Section: Introductionmentioning

confidence: 99%

Importance of the vertical incisor relationship in the prediction of the soft tissue profile after Class III bimaxillary surgery

Jakobsone

Stenvik

Espeland

2012

Objective: To quantify the relative soft tissue profile response to the skeletal changes resulting from bimaxillary surgery to correct Class III malocclusion in patients with different vertical incisor relationships presurgery. Materials and Methods: The sample comprised lateral cephalograms of 80 consecutive patients before and 2 months after surgery. All patients had one-piece Le Fort I and bilateral sagittal split osteotomies. Patients were divided in three subgroups according to their preoperative characteristics, as follows: (1) open-bite patients, (2) patients with positive overbite and the upper lip resting on upper incisors, and (3) patients with positive overbite and the upper lip resting on lower incisors (lipblock). Trimmed means of soft to hard tissue ratios were calculated for the subgroups. Regression analyses were performed to examine factors influencing the soft tissue changes. Results: There were strong correlations between the horizontal movement of upper incisors and upper lip in patients with open bite (r 5 0.77) and in patients with positive overbite and upper lip resting on upper incisors (r 5 0.85). The upper lip followed the maxilla with a ratio of 0.5:1. In patients with lip-block, the association between maxillary repositioning and upper lip changes was weak. In all groups a strong association between horizontal soft and hard tissue changes was observed for the lower lip and chin, but the pattern differed depending on the vertical movement of the mandible. Conclusions: In the prediction of soft tissue response it is important to take into account the vertical incisor relationship, particularly in patients with lip-block. (Angle Orthod. 2012;82:441-447.)

“…Although orthodontic treatment and the associated surgical procedures are well planned to achieve an ideal occlusion as well as a balance between the facial profile and function, unwanted changes in the soft tissue, other than the manipulated structures such as the nose, are sometimes encountered. [1][2][3] Many studies have reported secondary morphological changes in the nose, including alar flaring after a Le Fort 1 osteotomy. [1][2][3][4][5][6] The changes might be advantageous for patients with a narrow nose, but they can have a negative effect on the overall esthetics of the face in those with a wide nasal width.…”

Section: Introductionmentioning

confidence: 99%

Nasal Changes after Surgical Correction of Skeletal Class III Malocclusion in Koreans

Chung

Lee

Park

et al. 2008

Objective: To quantify the changes in the nose after bimaxillary surgery to correct skeletal Class III malocclusion and to test the hypothesis that there is no change in the nasal width following bimaxillary surgical correction of skeletal Class III when a nasal cinch is properly used. Materials and Methods: Sixty-five adult Korean skeletal Class III patients who had received maxillary advancement/impaction and mandibular set-back surgery in conjunction with an alar base cinch suture were evaluated. The anthropometric variables of the nasal region were measured directly on the soft-tissue surface before and 6 months after surgery. Results: After surgery, the alar width and alar base width had increased significantly (P Ͻ .001), while the nasal tip projection decreased (P Ͻ .001). The nostril morphology also showed widening (P Ͻ .001). There was a trend for females with a narrow alar width presurgically to have a larger amount of nasal widening compared with those with a broader alar width (P Ͻ .05). Conclusion:There is a high probability of nasal and nostril widening after bimaxillary surgery for skeletal Class III malocclusion in Koreans despite the careful performance of alar cinch suture. Nevertheless, the authors believe that alar cinch suture was positive in limiting the nasal widening to the minimum and would consider routine application during bimaxillary surgery for skeletal Class III especially for female patients with a narrow nose who are susceptible to these changes.