Three-dimensional Nasolabial Morphologic Alterations Following Le Fort I

Abstract

Background:Le Fort I osteotomy imparts significant changes to the nasolabial region. Past studies have relied on 2-dimensional data and have not delineated differences among various Le Fort I subtypes. The purpose of this study is to 3-dimensionally analyze Le Fort I–induced nasal and lip changes comparing advancement alone versus widening alone [surgically assisted maxillary expansion (SAME)] versus advancement and widening. We hypothesize that the combination of maxillary advancement with widening will result in the most profound changes.Methods:A retrospective cohort study was performed. Included Le Fort I patients were grouped as: (1) nonsegmental straight advancement, (2) widening without advancement, and (3) segmental advancement and widening. Pre- and postoperative 3-dimensional photogrammetry (Canfield) were analyzed. Anthropometric landmarks were placed and measured by 2 independent observers. Statistics involved both paired and unpaired t tests (significance = P < 0.05).Results:One hundred eight photogrammetric data sets were analyzed, including 46 single-piece, 26 SAME, and 36 segmental. Significant postoperative nasal changes were observed within each intragroup analysis. The most dramatic changes were seen after segmental Le Fort I with advancement and widening, which included alar base width, alar width, nostril width, and soft triangle angle, all P < 0.05.Conclusions:Le Fort I osteotomy results in significant alteration of the nasolabial morphology. This is the first study to 3-dimensionally analyze nasal changes that occur comparing maxillary advancement alone versus widening alone (SAME) versus advancement with widening. These objective data permit improved patient counseling and surgical planning.

Review of Nasal Changes With Maxillary Orthognathic Surgery

“…Widening of the alar base occurs following almost all maxillary osteotomies, especially with impaction and/or advancement( 6 ) or segmental advancement and widening ( 7 ).It is the most consistently reported change in the literature ( 6 , 7 , 8 , 9 , 10 ). It has also been noted to occur with surgically assisted maxillary expansion ( 7 , 11 , 12 ). The most likely explanation for this is the elevation of the periosteum off the anterior surface of the maxilla, together with the muscles and ligaments stabilizing the alar region ( 13 ).…”

“…upturning of the nasal tip) and the change in the inclination of the upper lip, Figure 6 ( 16 ). For instance, in maxillary advancement procedures the upper lip would be advanced leading to a reduction in the lower component but if there is considerable upturning of the nasal tip there would be an increase in the upper component and the overall resultant effect is most commonly an increase in the nasolabial angle ( 7 , 15 ). There tends to be a decrease in the nasolabial angle following maxillary impaction, which can also be coupled with deepening and accentuation of the nasolabial groove.…”

The Technique Of Bimaxillary Osteotomy With The Help Of Intermediate Kappa-Splints For The Elimination Of Upper Retrognathy In Patients With Congenital Clefts Of The Upper Lip And Palate

“…We regard the high relapse rate in traditional surgery as an imperfection of the bimaxillary osteotomy technique, as sagittal movement of the upper jaw is carried out arbitrarily, at the discretion of the surgeon, without any technique. The displacement plane can be distorted, especially with partial secondary adentia [2,3,4].…”

Does the Nostril Shape Change After Le Fort I Advancement in Patients With Unilateral Complete Cleft Lip?

“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Previous reports have examined the effect of maxillary advancement on nasolabial configuration, predominantly in patients without cleft lip and palate, for whom the possibility of secondary iatrogenic effects on nasal appearance must be carefully considered. 15,16,19,20 Cephalometric and anthropometric studies documenting the soft tissue changes after Le Fort I advancement in patients with cleft lip and palate have noted thinning of the upper lip, 3 shortening of the nose, increased nasal tip projection, 10,17 and alar widening. 10,15,17,18 Laser scanning has been used to measure the cheek, perialar, and nasal projection in patients with cleft lip and palate before and after Le Fort 11 and to follow the occurrence of relapse over time.…”

“…10,15,17,18 Laser scanning has been used to measure the cheek, perialar, and nasal projection in patients with cleft lip and palate before and after Le Fort 11 and to follow the occurrence of relapse over time. 12 In recent years, 3-dimensional (3D) photogrammetry has been used to better characterize the changes that occur in the nasal configuration after maxillary advancement [19][20][21] by eliminating patient movement and parallax. However, these studies limited their assessment to the nasal width, length, and projection, columellar width and length, and columella-labial angle.…”