Quantitative Assessment of Nasal Changes After Maxillomandibular Surgery Using a 3-Dimensional Digital Imaging System

Abstract

Objective: To evaluate nasal changes after maxillomandibular surgery by means of images taken with a 3-dimensional digital camera. Design: Thirty-two patients (26 female and 6 male) with preoperative and postoperative 3-dimensional photographs were studied. The patients underwent maxillary movement with impaction (upward rotation), maxillary movement with lengthening (downward rotation), or maxillary movement without rotation. With the 3-dimensional imaging software, preoperative and postoperative calculations were performed for interalar width, internostril width, nasal tip projection, and columellar length from the 3-dimensional digital images. The nasolabial angle was also measured. Results: Postoperative interalar and internostril widening was significant (PϽ.05) for all 3 categories of maxillary movement. However, there was no statistically significant change in nasal tip projection and columellar length. Interestingly, movement of the maxilla with upward rotation did show a statistically significant decrease in the nasolabial angle. Conclusions: Changes to the nose clearly occur after orthognathic surgery. There was a statistically significant increase in postoperative interalar width and internostril width with maxillary movement. However, no clear correlation could be determined between amount of change and maxillary movement. Interestingly, maxillary advancement did not show any significant change in nasal tip projection or columellar length, with data showing both increases and decreases in measurements. The nasolabial angle in patients who underwent maxillary advancement with impaction (upward rotation) was the only measurement that showed a statistically significant increase.

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

“…The morphologic changes in the external nose are mainly accompanied by positional changes in the maxilla through Le Fort 1 osteotomy. 2,4,6,16 In this study, the direction of maxillary movement after the Le Fort 1 osteotomy was mainly advancement and posterior impaction, resulting in a steeper occlusal plane. Although the skeletal Class III malocclusion of Koreans is primarily due to mandibular prognathism (48%) rather than a retrognathic maxilla, 17 the prevalence of bimaxillary surgery in the Korean orthodontic population is much higher than the mandibular set back alone.…”

“…[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. This is extremely important particularly for the Asian population because their noses have a wider width and flatter appearance than European Americans, [7][8][9] while the overall prevalence of severe skeletal Class III requiring orthognath- ic surgery is apparently high.…”

Reliability of reference distances used in photogrammetry

“…27,28 Several authors have published the profile and frontal characteristics of the face by collecting the data via anthropometric measurements [6][7][8][9][10] or by using threedimensional imaging techniques. 15,19,23,25,32 The determination of the reliability of 2-dimensional photogrammetry for soft tissue evaluation might provide clinicians the ability to assess soft tissue from both profile and frontal views after orthodontic treatment.…”

“…[3][4][5] It is not possible to evaluate the soft tissues from the frontal view by using cephalometric radiographs. In addition to cephalometric radiographs, soft tissue evaluation has been carried out by means of different methods such as anthropometry, [6][7][8][9][10] two-or threedimensional photogrammetry, [11][12][13][14][15][16][17][18][19][20][21][22][23] and three-dimensional imaging techniques. 24,25 Among these methods, two-dimensional photogrammetry has the advantage of being a basic, noninvasive, cost-effective, and quick method that requires minimal time and equipment in the assessment of soft tissue.…”

Skeletal Class III and open bite treated with bilateral sagittal split osteotomy and molar intrusion using titanium screws

“…[5][6][7][8][9][10][11][12] However, surgical invasiveness of two-jaw surgery is greater than that of mandibular surgery alone. Furthermore, in some patients, secondary morphological changes in the nose, such as alar flaring, have occurred after superior repositioning of the maxilla with Le Fort I osteotomy, [13][14][15][16][17][18] and soft tissue procedures such as rhinoplasty are therefore needed subsequently. 19 Recently, a new treatment method for anterior open bite with skeletal Class I and II that employs molar intrusion via anchorage with an implant such as a titanium screw has been reported.…”