The effect of orthognathic surgery on the lip lines while smiling in skeletal class III patients with facial asymmetry

A novel pictorial smile chart: Reliability and validity

INTRODUCTION

Smile analysis provides data on the positive and negative elements of a patient's smile. We aimed to develop a simple pictorial chart to record relevant parameters of the smile analysis in a single diagram and to investigate the reliability and validity of this chart.

METHODS

A panel of 5 orthodontists developed a graphical chart, which was reviewed by 12 orthodontists and 10 orthodontic residents. The chart comprises facial, perioral, and dentogingival zones analyzing 8 continuous and 4 discrete variables. The chart was tested on frontal smiling photographs of 40 young (aged 15-18 years) and 40 old (aged 50-55 years) patients. All measurements were performed twice with an interval of 2 weeks by 2 observers.

RESULTS

Pearson's correlation coefficients for observers and age groups varied from 0.860 to 1.000 and between observers from 0.753 to 0.999. Minor significant mean differences were found between the first and second observations, which were not clinically relevant. The kappa scores for the dichotomous variables were in perfect agreement. To test the sensitivity of the smile chart, differences between the two age groups were assessed as differences because aging is expected. In the older age group, philtrum height and visibility of mandibular incisors were significantly larger, whereas the upper lip fullness and buccal corridor visibility were significantly lesser (P <0.001).

CONCLUSIONS

The newly developed smile chart can record essential smile parameters to aid diagnosis, treatment planning, and research. The chart is simple and easy to use, has face and content validity and good reliability.

Effect of Orthognathic Surgery on Movement of the Cheilion

The cheilion (Ch), corner of the mouth, is the soft-tissue landmark where the upper and lower lips intersect. Orthognathic surgery can modify Ch position, which can affect facial esthetics. The aims were to evaluate Ch movements resulting from Le Fort I maxillary advancement with maxillary impaction or downgrafting, and with mandibular advancement or setback, and to investigate relationships between surgical movements and Ch movements. The 45 patients had undergone bilateral sagittal split ramus osteotomy with Le Fort I advancement surgery. They were divided into 4 groups according to surgical movement direction. Preoperative and postoperative photographs were calibrated. Standardized methods were used to identify and measure preoperative and postoperative Ch positions. Significant correlations were detected between extent of maxillary downgrafting and inferior movement of the Ch in group 1 (r=0.988, P=0.001) and group 3 (r=0.915, P=0.001). Also, significant correlations were detected between extent of mandibular advancement and anterior movement of the Ch in group 3 (r=0.561, P=0.046) and group 4 (r=0.661, P=0.005). The findings indicate that, in patients who undergo bilateral sagittal split ramus osteotomy/Le Fort I surgeries, mandibular advancement moves Ch anteriorly and maxillary downgrafting moves Ch inferiorly.

Comparative stability and outcomes of two surgical approaches for correction of class III asymmetry with lip or occlusal cant

OBJECTIVES

To assess and compare the stability and outcomes of the two surgical approaches for patients with roll asymmetry.

MATERIALS AND METHODS

A total of 50 adult patients were consecutively recruited for this prospective study. Patients with class III asymmetry and lip or occlusal cant who underwent bimaxillary surgery were grouped according to surgical approach: asymmetric posterior impaction on both sides (API, n = 31) and posterior impaction on one side and posterior extrusion on the other side (PIE, n = 19). Postsurgical stability and outcomes between groups were determined with cone-beam computed tomography for facial midline, lip, and occlusal cant at 1 week (T1), and at least 12-month postsurgery (T2, completion of orthodontic treatment).

RESULTS

Presurgery, the upper anterior occlusal cant and lip cant were significantly greater for the PIE group (p < 0.05). Postsurgery (T2), the mandible moved upward and rotated upward in both groups. However, the upward rotation was significantly greater in the PIE group compared with the API group. Although the two approaches resulted in significant improvements in facial symmetry, the deviation in the facial midline remained under-corrected for most API patients.

CONCLUSIONS

Patient outcomes for mandibular stability and facial symmetry differed between the two surgical approaches for correction of class III asymmetry with lip or occlusal cant.

CLINICAL RELEVANCE

The findings of this study suggest that planned over-correction is a reasonable option for the approach of asymmetric posterior impaction on both sides.

[Orthognathic surgery of mandibular asymmetry: which results can we expect with and without chin wing? A cohort out of 51 cases]

INTRODUCTION

The aim of this retrospective cohort is to evaluate the amount of postsurgical correction of soft and hard tissues in patients with mandibular asymmetries and to compare the results with and without surgery of the lower mandibular contour (chin wing…).

MATERIAL AND METHOD

Mandibular asymmetries cases of three surgeons were systematically included. The angles of deviation of the chin, bi-commissural, bi-gonic and occlusal were measured on face photography and radiography. A pre and post-surgical comparison was performed and the amount of correction was analyzed via the Wilcoxon statistical test.

RESULTS

51 patients (44 women and 7 men) were included. After surgery, the correction is significant for all measurements with an improvement of 44 to 60% depending on the measured angles. No patient is normalized but the small initial mandibular asymmetries are the closest to normal after surgery. The correction of the bi-commissural angle is controlled without being optimal (60% correction). The difficulty remains the horizontalization of the bi-gonial plan which is only corrected at 45%. Patients with mandibular margin surgery (chin wing…) showed the greatest improvement in bi-gonial (p = 0.0142) and occlusal (p = 0.0154) angles.

CONCLUSION

If surgery allows a significant correction of facial dissymmetry, this is not complete. Surgical procedures on the lower edge of the mandible such as the chin wing could provide a better correction especially for bi-gonial and occlusal angles.

Upper Lip Asymmetry During Smiling: An Analysis Using Three-Dimensional Images

Objective

The aim of this study was to use three-dimensional images to determine the presence of upper lip asymmetry at rest and during smiling in a group of individuals with no history of orthodontics or facial cosmetic surgery.

Methods

Standardized three-dimensional frontal resting and smiling images of 54 volunteers were analyzed using the 3dMDvultus software (3dMD, Atlanta, GA). Measurements were made from the soft tissue nasion, ipsilateral ala, subnasale, and menton to the right and left commissures of the lip. A 2.5 mm or greater difference between the right and left sides was defined as an asymmetry. The agreement on the presence or absence of asymmetry between the subjects' states of rest and smiling was determined by the McNemar's chi-squared test. Statistical significance was defined as p<0.05.

Results

Menton was the most stable facial landmark to evaluate the upper lip symmetry at rest and during smiling (p=0.002). Using menton as a landmark, only one of the 54 subjects showed asymmetry while resting, but 12 (22%) showed asymmetry when smiling.

Conclusion

As part of treatment planning for orthodontics or orthognathic surgery, patients should be evaluated for the upper lip symmetry during resting and smiling. The presence of asymmetry during smiling is a significant clinical problem that needs to be recognized so that patients can be informed about the effect it can have on the final esthetic result.

The Impact of the Use of Kinesio Taping Method on the Reduction of Swelling in Patients After Orthognathic Surgery: A Pilot Study

BACKGROUND Orthognathic surgery (OGS) is associated with extensive surgical intervention within the soft and hard tissues of the facial region of the skull leading to inflammatory reactions. The presence of postoperative swelling indicates the accumulation of exudate or transudate; both these fluids occur in surgery. Massive swelling is a significant problem, because the tension of tissues intensifies pain sensations. The aim of the study was to evaluate the effectiveness of the kinesio taping method (KT) in patients after orthognathic surgery in the area of the facial skull in terms of eliminating postoperative swelling. MATERIAL AND METHODS The study of the impact of kinesiology tape applied after orthognathic surgery to the craniofacial area on the elimination of swelling was performed in sixteen patients who suffered from this complication after bilateral sagittal split osteotomy. RESULTS The swelling was shown to be reduced after KT; within the same study the differences were statistically significant between the left and right sides and for the same side (p<0.05). The application of the lymphatic kinesio taping method led to the reduction of tension in the affected area and restoration of proper lymphatic circulation in the region covered by swelling. This allows for the improvement of the blood and lymph microcirculation and activation of self-healing processes. CONCLUSIONS The analysis of the impact of the practical use of the lymphatic KT on complications after orthognathic surgery revealed that it had a beneficial effect on the reduction of swelling. The use of the KT method seems promising because it is simple to carry out, not traumatic, economical and rarely causes undesirable allergies.

Nasal Deviation in Patients With Asymmetric Mandibular Prognathism

PURPOSE

This study was aimed to evaluate the nasal deviation in patients with asymmetric mandibular prognathism.

MATERIALS AND METHODS

Thirty-five patients with skeletal class III malocclusion were included in the study. Significant mandibular asymmetry of >4 mm menton deviation in three-dimensional (3D) reformatted cone beam computed tomography images was defined as asymmetry group (n = 20). Patients without mandibular asymmetry served as control group (n = 15). The mandibular asymmetry was evaluated pre- and postoperatively.

RESULTS

Nasal tip was significantly shifted to the deviated side of the mandible (short side) in the asymmetry group, as compared to the control group (1.5 ± 0.9 degree, P < 0.01). Alar base angle (ABA) was significantly narrower in nondeviated side (long side) than in the deviated side in asymmetry group. However, control group showed no bilateral difference in ABA. Correction of deviated mandibular prognathism by isolated mandibular surgery resulted in change in the ABA but not the columella base position or nasal asymmetry. ABA on nondeviated side significantly decreased in proportion to the amount of transverse menton movement by surgery (r = -0.560, P < 0.01).

CONCLUSION

Our results showed that mandibular chin deviation was accompanied by nasal deviation. Isolated mandibular surgery can potentially influence the alar base position on the contralateral side of deviation but not the nasal tip asymmetry. Therefore, clinicians should inform patients preoperatively of the fundamental limitation of mandibular surgery in cases with preexisting nasal asymmetry.

Perioral soft tissue change after isolated mandibular surgery for asymmetry patients

INTRODUCTION

This study was intended to determine whether isolated mandibular surgery for the correction of asymmetry could also change perioral soft tissue asymmetry.

PATIENTS AND METHODS

Skeletal class III patients who had undergone mandibular set-back surgery were included. The subjects were composed of two groups with (n = 20) or without (n = 30) menton (Me) deviation over 4 mm. The perioral lip landmarks were analyzed on three-dimensional image from cone-beam computed tomography taken before and 6 months after the operation. The bilateral and inter-group differences and pre- and post-operative changes were statistically analyzed.

RESULTS

The corner of mouth on the deviated side was 1.9 mm shorter vertically than that on the contralateral side in patients with asymmetry. After mandibular surgery, the deviated Me moved 5.5 mm to the contralateral side and the lip canting was corrected by 2.4° in the asymmetry group. The degree of Me deviation was significantly correlated with the degree of midline asymmetry in perioral soft tissue landmarks including subnasale, upper and lower lip midline. The predictor variable that affected the changes in lip cant was the surgical correction of Me deviation.

DISCUSSION

The correction of chin deviation by isolated mandibular surgery could significantly improve the subnasal and lip asymmetry.