Journal of Craniomaxillofacial Research 2017. 4(2):360-365.

Inferior scleral show changes following le fort I osteotomy in CL III patients with maxillary retrusion
Shahrooz Shafaee Fard, Mehdi Sezavar, Farzin Sarkarat, Amin Nowrouzi, Mohammad Masoud Yazdani


Introduction: In a balanced and symmetric face no sclera should be exposed below the irises. This study evaluated the inferior sclera exposure changes after maxillary advancement in skeletal cl III patients.
Materials and Methods: Eight consecutive patients (4 male and 4 female) with maxillary deficiency who underwent Le Fort I osteotomy were assessed using adobe photoshop CS5. Inferior sclera height to total eye height proportion was determined in both eyes in each patient and the propotional changes before and six month after surgery was statistically analyzed using Wilcoxon signed–rank test.
Results: Average maxillary advancement was 3.75 mm at the incisors. Proportion of inferior
sclera to total eye height decreased by a ratio of 8% (p<0.001) in total 16 eyes of 8 patients. All 8
patients achieved a decrease of their scleral show. None of the patients required further cosmetic
procedures in preorbital region.
Conclusion: Maxillary advancement in CI III patients with existing excessive scleral exporsure changes the lower lid position and leads to significant decreased scleral show.
Key words: Sclera show, Le fort osteotomy, skeletal cl III, Orthognathic Surgery.


Sclera show; Le fort osteotomy; skeletal cl III; Orthognathic Surgery.

Full Text:



Gunter JP,: Aesthetic analysis of the eyebrows. Plast Reconstr Surg 99: 1808, 1997.

Leob. R: Scleral show. Aesthetic Plast Surg. 1988 Aug; 12 (3): 165-70.

Posnick JC, Sami A: indivdulas with a long face growth pattern and excess inferior scleral expo- sure: is there improvement after maxillary (le fort I) advancement and vertical shorting? J Oral Max- illofac Surg. 2015 Sep; 73 (9): 1809-15.

Soydan SS, Bayram B: Change in inferior sclera exposure following le fort I osteotomy in patients with midfacial retrognathia. J Oral Maxillofac Surg. 2014 Jan, 72 (1): 166-e 15.

Turvey T.A: Comparison of changes in scleral expo- sure following modified le fort III osteotomy ver- sus le fort I osteotomy with maxillary bone graft- ing. AAMOS, 2014, oral abstract track 2, e- 25.

Naini FB: Facial Aesthetics, consepts & clinical diagnisos – West Sussex, UK, Wiley–Blackwell ,2011, p 199.

Flowers RS: The art of eyelid and aesthetics: mul- tiracial surgical consideration. Clin Plast Surg 14:703, 1987.

MC Curdy JA: Beautiful eyes: characteristics and application to aesthetic surgery, Facial Plast Surg 22: 204, 2006.

Fonseca RJ: oral and maxillofacial surgery: Aesthet- ic Blephoraplasty. 1ed, vol 6, chapter 14,p 351-53. WB Saunders company, 2000.

Meneghini F: Aesthetic Facial Surgery, elements, principles techniques. Padova, Italy, Springer,2005.

Yaremchuk MJ: Making concave faces convex.Aesthetic Plast Surg. 29: 141, 2005.

Yaremchuk MJ: improving periorbital appearance in the morphologically prone. Plast Reconstr Surg . 114: 980, 2004.

Yaremchuk MJ: Periorbital skeletal augmentation to improve blepharoplasty and midfacial results. Plast Reconst Surg. 2009 Dec; 124 (6): 2151-60.

Coleman SR: the technique of periorbital lipoin- filtration: operative techniques. Plast Reconst Surg 1: 120-134, 1994.

Hinder UT: nasal bone, maxillary and infraorbit- al implants. Clin Plast Surg. Jan; 18 (1): 87- 105.1991,

Trady ME, Thaomas JR, Brown JR: facial aesthetic surgery. St. Louis, Mosby, 1995.

Mladick RA: aesthetic surgery of the facial skele- ton. Clin Plast Surg 1991; 18: 29-38.

Rosen HM: maxillary advancement for mandib- ular prognathism: indications and rationale. Plast Reconst Surg; 87: 823-28, 1991,

Yaremchuk MJ: Infraorbital rim augmentation.Plast Reconst Surg. 107: 1585-95, 2001.

Obwegesser H: Surgical correction of small retrodisplaced maxilla: the dish- face deformity. Plast Reconst Surg 527-35, 1970.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.