Primary Maxillary Deficiency Dentofacial Deformities: Occlusion and Facial Esthetic Surgical Outcomes

Can the Upper Vermilion and the Nasolabial Fold Be Changed With Orthognathic Surgery?

BACKGROUND

Retrusive profiles show an appearance of aging with an under-projected vermilion and pronounced nasolabial folds due to deficient bone support.

PURPOSE

A study was made of the association between orthognathic surgery and changes in the nasolabial and vermilion areas in patients with retrusive profiles.

STUDY DESIGN, SETTING, SAMPLE

A retrospective cohort study evaluated patients subjected to bimaxillary surgery according to the Barcelona Line (BL) protocol during 2021 at Teknon Medical Center (Barcelona, Spain). Subjects with craniofacial syndromes, facial esthetic procedures, and dental rehabilitations involving lip changes, were excluded.

PREDICTOR VARIABLE

The predictor variable was the timing of cephalometric measures, reported as T0 (preoperatively), T1 (1 month after surgery), and T2 (after 1 year of follow-up).

MAIN OUTCOME VARIABLE

The outcome variable corresponded to the soft tissue changes of the nasolabial and vermilion area, reported as the nasolabial fold length and angle, nasolabial angle, upper lip concavity, vermilion length, and upper lip sagittal distance from BL.

COVARIATES

The covariates comprised patient demographic data, the surgical-orthodontic protocol, and the magnitude and direction of the skeletal movements.

ANALYSES

Descriptive and inferential analyses were performed based on analysis of variance, the Bonferroni test, Pearson's linear coefficient, the nonparametric Mann-Whitney U-test, Kruskal-Wallis test, and multiple linear regression models. Statistical significance was considered for P < .05.

RESULTS

The sample comprised 27 subjects with a mean age of 32.5 ± 11.2 years. A mean decrease in nasolabial angle of 5.5 ± 6° was recorded (P < .001), with a shortening of the nasolabial fold length of 4.4 ± 7.6 mm (P = .019). An increase in upper lip concavity angle of 14.4 ± 12° was recorded (P < .001), along with a vermilion lengthening of 1.6 ± 1.3 mm (P < .001) and an increase in upper lip sagittal distance to BL of 5.7 ± 7.3 mm (P = .001), indicating a more projected and everted upper vermilion.

CONCLUSIONS AND RELEVANCE

When adequate dentoskeletal support is provided by specific positional changes of the jaws planned through orthognathic surgery, the length of the nasolabial fold decreases, and the upper vermilion lengthens and becomes slightly everted.

Common Patterns of Developmental Dentofacial Deformities: A Biologic Classification System

Jaw disharmonies that are recognized after birth and that present in association with the pre-pubertal growth spurt are called developmental dentofacial deformities. These deformities occur during the normal growth phase of the face with degrees of either excess or deficiency in one or more vectors of the jaws. Clinical observation combined with radiographic analysis confirms that developmental dentofacial deformities tend to occur in 6 distinct and repetitive biologic patterns. Once the individual’s jaw growth pattern is known, the natural progression of their deformity, the functional consequences on speech articulation, chewing ability, swallowing mechanism, and breathing, and the locations of skeletal dysmorphology that require surgical intervention fall into place. The purpose of the manuscript is to review the 6 common patterns.

Challenges in the Successful Reconstruction of Cleft Lip and Palate: Managing the Nasomaxillary Deformity in Adolescence

The surgical techniques and execution of primary cleft lip and palate repair are no longer the greatest challenge to achieving successful rehabilitation for those born with facial clefting (i.e., bilateral and unilateral cleft lip and palate). Despite a surgeon's best efforts, when cleft palate repair is carried out during infancy, by the mixed dentition, a majority will demonstrate nasomaxillary deficiency. The cleft team's commitment to a family under their care is to ensure that the newborn reaches adulthood reconstructed without need for special regard to their original birth malformation. Guiding principles are provided for the accurate diagnosis and reliable reconstruction of the bilateral and unilateral cleft lip and palate adolescent/adult who presents with nasomaxillary deficiency and any residual oronasal fistula, bony defects, cleft dental gap(s), nasal obstructions, and associated facial dysmorphology. Successful orthognathic surgery provides a stable foundation on which any remaining soft-tissue cleft lip or cleft nasal deformities can be accurately assessed and then reconstructed.

Selected Orthodontic Principles for Management of Cranio-Maxillofacial Deformities

An understanding of fundamental orthodontic principles involving diagnosis, treatment planning, and clinical strategies is essential for achieving successful outcomes in the treatment of craniofacial patients, particularly cleft lip/palate. This article focuses on: customizing a mandibular dental arch form using the WALA ridge; accurately diagnosing the maxillary skeletal transverse dimension (cusp to cusp/fossa to fossa); coordinating the upper dental arch with the lower; using a smiling profile and glabella vertical to assess anteroposterior jaw position; and leveling the mandibular curve of Spee while considering the lower one-third of the face. These concepts influence treatment outcomes to the extent they are used.

The Effect of Cleft Orthognathic and Nasal Reconstruction on Perceived Social Traits

The investigators hypothesized that a layperson’s social perceptions of an adolescent cleft lip and palate (CL/P) patient are more favorable after orthognathic surgery and definitive nasal reconstruction.

Orthognathic Surgery Has a Significant Positive Effect on Perceived Personality Traits and Perceived Emotional Facial Expressions in Subjects with Primary Maxillary Deficiency

Background:

Crowdsourcing is increasingly being used in medical research to obtain the opinion of laypeople. The investigators hypothesized that a layperson’s perception of a primary maxillary deficiency (PMD) dentofacial deformity (DFD) patient is more favorable after orthognathic surgery with regard to perceived personality traits and emotional facial expressions.

Methods:

The investigators implemented a survey, distributed through Amazon.com’s Mechanical Turk crowdsourcing platform, to compare 6 perceived personality traits and 6 perceived emotional traits before and >6 months after orthognathic surgery in subjects through standardized facial photographs. The sample was composed of 20 subjects randomly selected from a PMD DFD database, treated by 1 surgeon all having undergone bimaxillary and chin orthognathic surgery. The outcome variable was change in each of 6 perceived personality and 6 emotional expression traits studied. Descriptive and bivariate statistics were computed. P-value of <0.05 was considered significant.

Results:

Five hundred respondents (raters) completed the survey. A majority of respondent raters were male (59%) and White (71%), ranging in age between 25 and 34 years (52%). After bimaxillary and chin orthognathic surgery, PMD subjects as a group were perceived to be significantly more dominant, more trustworthy, more friendly, more intelligent, more attractive, and less threatening. They were also perceived as happier and less angry, less surprised, less sad, less afraid, and less disgusted than before surgery (P < 0.05).

Conclusions:

We confirmed that laypeople consistently report positive changes in a PMD DFD subject’s perceived personality traits and perceived emotional expressions after bimaxillary and chin orthognathic surgery.

Primary Mandibular Deficiency Dentofacial Deformities: Occlusion and Facial Aesthetic Surgical Outcomes

PURPOSE

The purpose of the present study was to document the malocclusion and facial dysmorphology in primary mandibular deficiency (PMD) subjects with chronic obstructive nasal breathing before treatment and the outcomes after bimaxillary orthognathic, genioplasty, and intranasal surgery.

PATIENTS AND METHODS

A retrospective cohort study of PMD subjects undergoing bimaxillary, chin, and intranasal surgery was implemented. The predictor variables were grouped into demographic, anatomic, operative, and longitudinal categories. The primary outcome variables were the initial postoperative occlusion achieved at 5 weeks postoperatively (T₂) and that maintained long-term more than 2 years after surgery (T₄). Six occlusion parameters were assessed: overjet, overbite, coincidence of dental midlines, Angle classification, molar vertical, and transverse positions. A second outcome variable was the facial esthetic results. Photographs were analyzed to document 7 facial contour characteristics.

RESULTS

Forty subjects met the inclusion criteria. Their age at surgery averaged 32 years (range 13 to 63). The study included 25 females (63%). The findings confirmed that the occlusion after initial surgical healing (T₂) met the objectives for all parameters in 39 of the 40 patients (98%). Most patients (35 of 40; 88%) achieved and maintained a favorable occlusion for each parameter in the long-term (mean 5 years, 3 months). Subjects requiring counterclockwise rotation of the maxillomandibular complex were more likely to a have recurrent anterior open bite in the long-term. Facial contour deformities on presentation included weak chin (80%), deep labiomental fold (90%), everted lower lip (100%), short neck-to-chin length (88%), obtuse neck-to-chin angle (85%), weak mandible angles (93%), and "bunching" of the neck soft tissues (85%). Before surgery, 88% of the subjects exhibited a minimum of 5 of the 7 facial deformities. Correction of all 7 facial deformities was confirmed in 86% of the subjects in the long-term.

CONCLUSIONS

Most PMD subjects achieved and maintained a corrected occlusion in the long-term. In the untreated subjects, a "facial type" was identified. Orthognathic surgery proved effective in correcting the associated facial dysmorphology in most patients.