Subnasal modified Le Fort I osteotomy: indications and results

Evaluation of soft tissue changes around the nose following subspinal Le Fort Ⅰ osteotomy

PURPOSE

This study sought to evaluate the effect of subspinal Le Fort Ⅰ osteotomy (SLFⅠO) and alar base chinch suture (ABCS) in preventing postoperative changes of nasal shape following maxillary movement of advancement-impaction (MAI) or advancement-downward (MAD) by analyzing changes of nasal soft tissue on computed tomography (CT) images.

METHODS

Forty-three Japanese patients with dentofacial deformity who underwent orthognathic surgery with SLFⅠO and ABCS were retrospectively examined. Maxillary movement and changes to soft tissues around the nose were analyzed using pre- and postoperative CT.

RESULTS

Increased nasal width and alar base width, upturning of the nasal tip and flattening of the nose occurred in both groups, with more prominent changes in MAI. MAD showed horizontal maxillary movement strongly correlated with changes in pronasale and subnasale. Preoperative nasal height correlated negatively with changes to nasal height in both groups, and to nasolabial angle and nasal tip angle in MAD. There were no correlations between the tightness of ABCS during operation and postoperative nasal soft tissue changes including nasal width.

CONCLUSION

Postoperative changes to nasal shape following SLFⅠO and ABCS need to be considered with advance movements of the maxilla, regardless of vertical maxillary movement. Postoperative pronasale and subnasale may be estimable from the amount of the maxillary advance movement in MAD. Postoperative changes in nasal shape may be more prominent in cases with low nasal height.

Do facial soft tissue thicknesses change after surgeries correcting dental malocclusions? An intra- and inter-patient statistical analysis on soft-tissue thicknesses in BSSO + LFI surgeries

OBJECTIVES

The aim of this study was to analyse changes in facial soft tissue thickness (FSTT) after corrective surgeries for dental malocclusion. The correlation between body mass index (BMI) and sex of patients and their FSTT before undergoing surgery was analysed.

MATERIALS AND METHODS

Cone beam computed tomography of seventeen patients that underwent Le Fort I osteotomy in combination with bilateral sagittal split osteotomy were collected. Hard and soft tissue landmarks were selected basing on the interventions. FSTT were computed, and measurements from pre- to post-operative were compared. The relationship between FSTT, sex, and BMI was investigated.

RESULTS

Considering the comparison between pre- and post-operative measurements, any significant difference emerged (p > .05). The Pearson's correlation coefficient computed between BMI and the FSTT (pre-operative) showed a correlation in normal-weight patients; the region-specific analysis highlighted a stronger correlation for specific landmarks. Higher median values emerged for women than for men; the subset-based analysis showed that women presented higher values in the malar region, while men presented higher values in the nasal region.

CONCLUSIONS

The considered surgeries did not affect the FSTT of the patients; differences related to BMI and sex were found. A collection of FSTT mean values was provided for twenty landmarks of pre- and post-operative of female and male subjects.

CLINICAL RELEVANCE

This exploratory analysis gave insights on the behaviour of STT after maxillofacial surgeries that can be applied in the development of predictive methodologies for soft tissue displacements and to study modifications in the facial aspect of the patients.

Le Fort I osteotomy and soft tissue response: A retrospective cohort study comparing three different techniques

The aim of this study was to evaluate the nasolabial soft tissues effects in three different Le Fort I osteotomy techniques using cone beam computed tomography (CBCT) evaluation of three-dimensional (3D) volume surfaces. A retrospective study was designed, and three groups were evaluated: group 1, patients who underwent conventional Le Fort I osteotomy; group 2, patients who underwent subspinal Le Fort I osteotomy; and group 3, patients who underwent conventional Le Fort I osteotomy with ANS recontouring or removal. CBCT evaluation was performed at two time points: T0, 1 week before surgery; T1, 6 months after surgery. A total of 90 patients were enrolled in this study (group 1: 30; group 2: 30; group 3: 30). Mean maxillary advancement was 4.26 mm. For group 1, mean change in inter-alar width was 2.29 ± 1.57 mm (minimum -2mm; maximum 6.1 mm; for group 2 it was 1.20 ± 1.56 mm (minimum -1.7 mm; maximum 5.9 mm), and for group 3 was 1.84 ± 1.76 mm (minimum -2.3 mm; maximum 5.9 mm). For group 1, mean change in alar base width was 1.69 ± 2.32 mm (minimum -4.8 mm; maximum 6,1 mm); in group 2 it was 0.85 ± 2.08 mm (minimum -4mm; maximum 6 mm), and group 3 was 1.21 ± 1.83 mm (minimum -2mm; maximum 5 mm). Results showed statistically significant differences in nasolabial area (P < 0.001). Within the limitations of the study it seems that subspinal Le Fort I osteotomy should be preferred when the priority is to avoid changes to the nasolabial region.

The effect of subspinal Le Fort I osteotomy and alar cinch suture on nasal widening

The aim of this retrospective study was to evaluate the relationships between upper jaw movements and nasal soft-tissue changes in patients who have undergone subspinal Le Fort I osteotomy combined with alar cinch suture. Single and multivariate linear regression analyses were used to examine the relationships between greatest inter-alar width (GAW) and maxillary advancement, maxillary impaction, and rotational movements. The database of our referral hospital was searched for patients who had undergone upper jaw surgery with a subspinal LFI osteotomy to correct dentoskeletal deformities between April 2012 and June 2016. Thirty-eight of the patients (15 men and 23 women) who were identified were eligible for inclusion. The average change in inter-alar width (ΔGAW) was +1.7 ± 1.2 mm. GAW increased by 0.3 mm (p < 0.0001) for each millimetre of maxillary advancement, and increased by 0.5 mm (p < 0.0001) for each millimetre of maxillary impaction. GAW increased by 0.2 mm for each degree of counterclockwise rotation of the occlusal plane (p < 0.0001). An analysis of our data compared with the current literature confirmed that subspinal Le Fort I combined with alar cinch suture reduced alar base widening.

Concomitant Dorsal Preservation Rhinoplasty and Orthognathic Surgery: A Technical Note

PURPOSE

In the present report, we have introduced a novel technique for concomitant Le Fort I surgery and dorsal preservation rhinoplasty and reviewed the reported data.

PATIENTS AND METHODS

Concurrent surgery could be considered a suitable option for patients requiring both upper jaw orthognathic surgery and rhinoplasty or those who are willing to undergo single-stage concomitant rhinoplasty and orthognathic surgery. In the present technical note, we have introduced a dorsal preservation rhinoplasty technique combined with Le Fort I surgery through an intraoral approach. The advantages of this technique include its conservative design, avoidance of a second surgery and anesthetic, the ability to correct possible nasal defects caused by the Le Fort I osteotomy, keeping the keystone area intact, and, most importantly, the possibility of concomitant surgery. However, recurrence of the hump and nasal pyramid lateralization are among the problems that could be associated with this technique. These disadvantages might necessitate revision surgery.

RESULTS

A total of 48 patients (23 females and 15 males) had undergone concomitant rhinoplasty and Le Fort I surgery using a modified dorsal preservation technique. No patient reported dissatisfaction with the results of surgery regarding the nasal and facial esthetics. No evidence of severe complications, such as saddle nose, severe deviation, airway compromise, or severe asymmetry, was observed postoperatively.

CONCLUSIONS

Based on our experience with patients and after at least 1 year of follow-up, the results of the present study suggest that this technique is straightforward and produces excellent results.

Effectiveness of subspinal Le Fort I osteotomy in preventing postoperative nasal deformation

PURPOSE

This study sought to determine the effectiveness of subspinal Le Fort I osteotomy (SLFIO) in preventing nasal deformation, by analyzing changes in the nasal profile on three-dimensional computed tomography (3D-CT) images.

PATIENTS AND METHODS

The participants were 39 Japanese patients with mandibular prognathism (6 men and 33 women) who underwent bilateral sagittal split ramus osteotomy and Le Fort I osteotomy with maxillary advancement: SLFIO was performed in 20 patients and conventional Le Fort I osteotomy (CLFIO) in 19 patients. All patients underwent modified alar base cinch suture, V-Y closure, and reduction of the piriform aperture. CT data acquired before and 1 year after the surgery were evaluated three-dimensionally with software to determine changes in the nasal profile.

RESULTS

Changes in alar width, alar base width, nasal length, and nasofrontal angle were significantly smaller following SLFIO than following CLFIO, although there were no significant differences in nasal projection, nasal tip angle, or nasolabial angle between two procedures.

CONCLUSION

SLFIO for anterior repositioning of the maxilla can prevent undesirable transverse soft tissue changes of the nose.

Total Maxillary Alveolar Osteotomy: Surgical Technique and Review of Its Efficacy

PURPOSE

The total maxillary alveolar osteotomy (TMxAO) is not commonly used to manage maxillary skeletal deformities. This article describes the technique, reviews its stability, and discusses its advantages over the more popular Le Fort I osteotomy.

MATERIALS AND METHODS

A series of 177 TMxAO patients satisfying the inclusion criteria from a cadre of 234 patients undergoing TMxAO between 1985 and 1993 were evaluated in a retrospective cohort study regarding achievement of predicted anatomic movements, stability of skeletal results, and preservation of inter-alar dimension. The patients were evaluated early postoperatively and at 11 to 14 months postoperatively, and the data were exposed to the Shapiro-Wilk test and analysis of variance and analyzed using SPSS software (version 21; IBM, Armonk, NY) at the 99% level of confidence (P ≤ .01).

RESULTS

Only in 58% of patients did the designed millimetric study model changes correspond precisely to the millimetric changes disclosed in a comparison of preoperative and early postoperative cephalograms. Comparison of early and late postoperative cephalograms, with infrequent exceptions, described millimetric instabilities of less than 2 mm and angular instabilities of less than 2°. Despite 2 significant outliers, the average inter-alar instability as determined by direct measurement was 0.19 mm.

CONCLUSIONS

This study suggests that the TMxAO compares favorably in stability with the Le Fort I osteotomy as recorded in the literature and, in terms of versatility, mobility of segments, avoidance of anatomic hazard, and preservation of nasal width, offers advantages in comparison.