Middle and lower facial soft tissue changes after maxillary advancement through conventional or high Le Fort I osteotomy
Abstract
Introduction: Maxillary advancement is applied extensively for malocclusion class III correction. This procedure is done using one of the two methods, Conventional or High. Maxilla moves in both vertical and horizontal and only in the horizontal directions in Conventional and High method respectively, so expecting a difference in facial soft tissue changes. In present study is a case series that describes this issue. Materials and Methods: The cases included 30 patients with class III malocclusion due to maxillary deficiency, whom underwent Le Fort I osteotomy for maxillary advancement in Shahid Beheshti Hospital in Babol, Iran during 1995 to 1995. According to surgical technique, the cases were placed in group 1 (Conventional) or group 2 (High). Maxillary advancement and changes in hard and soft tissue of the middle and lower facial regions where measured through tracing on the lateral cephalometry. Intra-group and inter-group statistical comparisons were done using SPSS20 software at significance level as 0.05.Result: The pre-surgical mean size of SNA, SNB, nasolabial and mentolabial angles was similar in two groups. In all patients, after surgery, SNA angle size was increased and SNB، nasolabial and Mentolabial angles size were decreased. The mean value of these change was similar in two groups. In group 2, the displacement of point A ‘(mean difference: 1.30 mm) and Labrale Superius (mean difference: 1.40 mm) were significantly more than group 1. The amount of displacement of SN (mean difference: 1.30 mm), Labrale Inferius (mean difference: 0.88 mm) and Pogonion (mean difference: 0.23 mm) points in group 2 was higher than that of group 1, but this difference was not statistically significant.Conclusion: It is needed strong evidence for decision about selecting High or Conventional approach maxillary advancement in terms of facial aesthetic aspects. So, further studies with larger sample sizes and cohort or quasi-experimental design is suggested.
1-Johnston C, Burden D, Kennedy D, Harradine N, Stevenson M. Class III surgical-orthodontic treatment: a cephalometric study. Am J Orthod Dentofacial Orthop. 2006 Sep;130(3):300-9.
2-Susarla SM, Tveit M, Dodson TB, Kaban LB, Hopper RA, Egbert MA. What are the defining characteristics of the most cited publications in orthognathic surgery? Int J Oral Maxillofac Surg. 2018 Nov;47(11):1411-1419. doi: 10.1016/j.ijom.2018.04.016. Epub 2018 May 21.
3-Malagón HO, Ayala-Ugalde FA, García-Cano E, Chang-Contreras JE. The U-Shaped Maxillary Osteotomy: A Novel Resource for the Treatment of the Middle Third Facial Hypoplasia. J Craniofac Surg. 2018 Sep;29(6):1412-1415. doi: 10.1097/SCS.0000000000004688.
4- Meewis J, Govaerts D, Falter B, Grisar K, Shaheen E, Van de Vyvere G, et al. Reaching the vertical versus horizontal target position in multi-segmental Le Fort I osteotomy is more difficult, but yields comparably stable results to one-segment osteotomy. Int J Oral Maxillofac Surg. 2018 Apr;47(4):456-464. doi: 10.1016/j.ijom.2017.10.004. Epub 2017 Nov 1.
5-Ghassemi M, Jamilian A, Becker JR, Modabber A, Fritz U, Ghassemi A. Soft-tissue changes associated with different surgical procedures for treating class III patients. J Orofac Orthop. 2014 Jul;75(4):299-307. doi: 10.1007/s00056-014-0224-x. Epub 2014 Jul 6.
6-Eshghpour M, Mianbandi V, Samieirad S. Intra- and Postoperative Complications of Le Fort I Maxillary Osteotomy. J Craniofac Surg. 2018 Nov;29(8):e797-e803. doi: 10.1097/SCS.0000000000004828.
7-He J, Wang Y, Hu H, Liao Q, Zhang W, Xiang X, et al. Impact on the upper airway space of different types of orthognathic surgery for the correction of skeletal class III malocclusion: A systematic review and meta-analysis. Int J Surg. 2017 Feb;38:31-40. doi: 10.1016/j.ijsu.2016.12.033. Epub 2016 Dec 24.
8-Kim YI, Park SB, Son WS, Hwang DS. Midfacial soft-tissue changes after advancement of maxilla with Le Fort I osteotomy and mandibular setback surgery: comparison of conventional and high Le Fort I osteotomies by superimposition of cone-beam computed tomography volumes. J Oral Maxillofac Surg. 2011 Jun;69(6):e225-33. doi: 10.1016/j.joms.2010.12.035. Epub 2011 Apr 15.
9-Jose Cherackal G, Thomas E, Prathap A. Combined Orthodontic and Surgical Approach in the Correction of a Class III Skeletal Malocclusion with Mandibular Prognathism and Vertical Maxillary Excess Using Bimaxillary Osteotomy. Case Rep Dent. 2013;2013:797846. doi: 10.1155/2013/797846. Epub 2013 Dec 22.
10-Hellak AF, Kirsten B, Schauseil M, Davids R, Kater WM, Korbmacher-Steiner HM. Influence of maxillary advancement surgery on skeletal and soft-tissue changes in the nose - a retrospective cone-beam computed tomography study. Head Face Med. 2015 Jul 9;11:23. doi: 10.1186/s13005-015-0080-y.
11-Lo LJ, Weng JL, Ho CT, Lin HH. Three-dimensional region-based study on the relationship between soft and hard tissue changes after orthognathic surgery in patients with prognathism. PLoS One. 2018 Aug 1;13(8):e0200589. doi: 10.1371/journal.pone.0200589. eCollection 2018.
12-Choi JW, Lee JY, Oh TS, Kwon SM, Yang SJ, Koh KS. Frontal soft tissue analysis using a 3 dimensional camera following two-jaw rotational orthognathic surgery in skeletal class III patients. J Craniomaxillofac Surg. 2014 Apr;42(3):220-6. doi: 10.1016/j.jcms.2013.05.004. Epub 2013 Jul 17.
13-Wang Z, Wang P, Zhang Y, Shen G. Nasal Airway Evaluation After Le Fort I Osteotomy Combined With Septoplasty in Patients With Cleft Lip and Palate. J Craniofac Surg. 2017 Jan;28(1):207-211. doi: 10.1097/SCS.0000000000003259.
14- Keller EE, Sather AH. Quadrangular Le Fort I osteotomy: Surgical technique and review of 54 patients. Journal of oral and maxillofacial surgery. 1990 Jan 1;48(1):2-11
15-San Miguel Moragas J, Van Cauteren W, Mommaerts MY. A systematic review on soft-to-hard tissue ratios in orthognathic surgery part I: maxillary repositioning osteotomy. J Craniomaxillofac Surg. 2014 Oct;42(7):1341-51. doi: 10.1016/j.jcms.2014.03.024. Epub 2014 May 21.
16-Naini FB, Cobourne MT, McDonald F, Wertheim D3. The aesthetic impact of upper lip inclination in orthodontics and orthognathic surgery. Eur J Orthod. 2015 Feb;37(1):81-6. doi: 10.1093/ejo/cju015. Epub 2014 Jul 12.
17-Naini FB, Gill DS, editors. Orthognathic surgery: principles, planning and practice. John Wiley & Sons; 2017 Feb 6.
18- Ghassemi M, Hilgers RD, Jamilian A, Shokatbakhsh A, Hölzle F, Fritz U,et al. Effect of maxillary advancement on the change in the soft tissues after treatment of patients with class III malocclusion. Br J Oral Maxillofac Surg. 2015 Oct;53(8):754-9. doi: 10.1016/j.bjoms.2015.06.001. Epub 2015 Jun 26.
19-Hoffman GR, Brennan PA. The skeletal stability of one-piece Le Fort 1 osteotomy to advance the maxilla; Part 2. The influence of uncontrollable clinical variables. Br J Oral Maxillofac Surg. 2004 Jun;42(3):226-30.
20-Costa F, Robiony M, Zorzan E, Zerman N, Politi M. Stability of skeletal Class III malocclusion after combined maxillary and mandibular procedures: titanium versus resorbable plates and screws for maxillary fixation. J Oral Maxillofac Surg. 2006 Apr;64(4):642-51.
21-Liebregts J1, Xi T, Timmermans M, de Koning M, Bergé S, Hoppenreijs T, et al. Accuracy of three-dimensional soft tissue simulation in bimaxillary osteotomies. J Craniomaxillofac Surg. 2015 Apr;43(3):329-35. doi: 10.1016/j.jcms.2014.12.012. Epub 2014 Dec 30.
22- Abdolreza Jamilian. Tracing technique and Landmark recognition .In: Principles of Cephalometric Tracing. Abdolreza Jamilian .Tehran: Shayan Nemoudar; 2016.
23-Azamian Z, Shirban F. Treatment Options for Class III Malocclusion in Growing Patients with Emphasis on Maxillary Protraction. Scientifica (Cairo). 2016;2016:8105163. doi: 10.1155/2016/8105163. Epub 2016 Apr 10
24-Ghassemi M, Ghassemi A, Showkatbakhsh R, Ahmad SS, Shadab M, Modabber A, et al. Evaluation of soft and hard tissue changes after bimaxillary surgery in class III orthognathic surgery and aesthetic consideration. Natl J Maxillofac Surg. 2014 Jul-Dec;5(2):157-60. doi: 10.4103/0975-5950.154819.
25-Oltramari-Navarro PV, de Almeida RR, Conti AC, Navarro Rde L, de Almeida MR, Fernandes LS. Early treatment protocol for skeletal Class III malocclusion. Braz Dent J. 2013;24(2):167-73. doi: 10.1590/0103-6440201301588.
26-Nagori H, Fattahi T. Maxillary advancement surgery and nasolabial soft tissue changes. J Medical and Dental Sciences. 2017;16:23-9.
27-Marşan G, Cura N, Emekli U. Soft and hard tissue changes after bimaxillary surgery in Turkish female Class III patients. J Craniomaxillofac Surg. 2009 Jan;37(1):8-17. doi: 10.1016/j.jcms.2008.07.004. Epub 2008 Sep 10.
28-Vasudavan S, Jayaratne YS, Padwa BL. Nasolabial soft tissue changes after Le Fort I advancement. J Oral Maxillofac Surg. 2012 Apr;70(4):e270-7. doi: 10.1016/j.joms.2011.11.022. Epub 2012 Jan 28.
29-Freihofer P. The lip profile after correction of retromaxillarism in cleft and non-cleft patients. J Maxillofac Surg 1976: 4: 136-41.
30-Mansour S, Burstone C, Legan H. An evaluation of soft-tissue changes resulting from Le Fort I maxillary surgery. Am J Orthod. 1983 Jul;84(1):37-47.
31-Gassmann CJ, Nishioka GJ, Van Sickels JE, Thrash WJ. A lateral cephalometric analysis of nasal morphology following Le Fort I osteotomy applying photometric analysis techniques. J Oral Maxillofac Surg. 1989 Sep;47(9):926-30.
32-Tiwari R, Chakravarthi PS, Kattimani VS, Lingamaneni KP. A Perioral Soft Tissue evaluation after Orthognathic Surgery Using Three-Dimensional Computed Tomography Scan. Open Dent J. 2018; 12: 366–376.
33-Rosen HM. Lip-nasal aesthetics following Le Fort I osteotomy. Plast Reconstr Surg. 1988 Feb;81(2):171-82.
34-Fernández-Riveiro P, Smyth-Chamosa E, Suárez-Quintanilla D, Suárez-Cunqueiro M. Angular photogrammetric analysis of the soft tissue facial profile. Eur J Orthod. 2003 Aug;25(4):393-9.
35-Rustemeyer J, Martin A. Soft tissue response in orthognathic surgery patients treated by bimaxillary osteotomy: cephalometry compared with 2-D photogrammetry. Oral Maxillofac Surg. 2013 Mar;17(1):33-41. doi: 10.1007/s10006-012-0330-0. Epub 2012 May 5.
36-Ragaey M, Van Sickels JE. Stability of large maxillary advancements using a combination of prebent and conventional plates for fixation. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Jan;123(1):29-36. doi: 10.1016/j.oooo.2016.08.019. Epub 2016 Sep 21.
37- Koerich L, Brunetto DP, Ohira ETB. The effect of hard tissue surgical changes on soft tissue displacement: a pilot CBCT study. Dental Press J Orthod. 2017 Sep-Oct;22(5):39-46. doi: 10.1590/2177-6709.22.5.039-046.oar.
38-Tseng YC, Cheng JH, Chen MY, Chen KJ, Chen CM. The changes of cheek line (lateral) and face line (frontal) after correction of mandibular prognathism. BioMed research international. 2018;2018.
2-Susarla SM, Tveit M, Dodson TB, Kaban LB, Hopper RA, Egbert MA. What are the defining characteristics of the most cited publications in orthognathic surgery? Int J Oral Maxillofac Surg. 2018 Nov;47(11):1411-1419. doi: 10.1016/j.ijom.2018.04.016. Epub 2018 May 21.
3-Malagón HO, Ayala-Ugalde FA, García-Cano E, Chang-Contreras JE. The U-Shaped Maxillary Osteotomy: A Novel Resource for the Treatment of the Middle Third Facial Hypoplasia. J Craniofac Surg. 2018 Sep;29(6):1412-1415. doi: 10.1097/SCS.0000000000004688.
4- Meewis J, Govaerts D, Falter B, Grisar K, Shaheen E, Van de Vyvere G, et al. Reaching the vertical versus horizontal target position in multi-segmental Le Fort I osteotomy is more difficult, but yields comparably stable results to one-segment osteotomy. Int J Oral Maxillofac Surg. 2018 Apr;47(4):456-464. doi: 10.1016/j.ijom.2017.10.004. Epub 2017 Nov 1.
5-Ghassemi M, Jamilian A, Becker JR, Modabber A, Fritz U, Ghassemi A. Soft-tissue changes associated with different surgical procedures for treating class III patients. J Orofac Orthop. 2014 Jul;75(4):299-307. doi: 10.1007/s00056-014-0224-x. Epub 2014 Jul 6.
6-Eshghpour M, Mianbandi V, Samieirad S. Intra- and Postoperative Complications of Le Fort I Maxillary Osteotomy. J Craniofac Surg. 2018 Nov;29(8):e797-e803. doi: 10.1097/SCS.0000000000004828.
7-He J, Wang Y, Hu H, Liao Q, Zhang W, Xiang X, et al. Impact on the upper airway space of different types of orthognathic surgery for the correction of skeletal class III malocclusion: A systematic review and meta-analysis. Int J Surg. 2017 Feb;38:31-40. doi: 10.1016/j.ijsu.2016.12.033. Epub 2016 Dec 24.
8-Kim YI, Park SB, Son WS, Hwang DS. Midfacial soft-tissue changes after advancement of maxilla with Le Fort I osteotomy and mandibular setback surgery: comparison of conventional and high Le Fort I osteotomies by superimposition of cone-beam computed tomography volumes. J Oral Maxillofac Surg. 2011 Jun;69(6):e225-33. doi: 10.1016/j.joms.2010.12.035. Epub 2011 Apr 15.
9-Jose Cherackal G, Thomas E, Prathap A. Combined Orthodontic and Surgical Approach in the Correction of a Class III Skeletal Malocclusion with Mandibular Prognathism and Vertical Maxillary Excess Using Bimaxillary Osteotomy. Case Rep Dent. 2013;2013:797846. doi: 10.1155/2013/797846. Epub 2013 Dec 22.
10-Hellak AF, Kirsten B, Schauseil M, Davids R, Kater WM, Korbmacher-Steiner HM. Influence of maxillary advancement surgery on skeletal and soft-tissue changes in the nose - a retrospective cone-beam computed tomography study. Head Face Med. 2015 Jul 9;11:23. doi: 10.1186/s13005-015-0080-y.
11-Lo LJ, Weng JL, Ho CT, Lin HH. Three-dimensional region-based study on the relationship between soft and hard tissue changes after orthognathic surgery in patients with prognathism. PLoS One. 2018 Aug 1;13(8):e0200589. doi: 10.1371/journal.pone.0200589. eCollection 2018.
12-Choi JW, Lee JY, Oh TS, Kwon SM, Yang SJ, Koh KS. Frontal soft tissue analysis using a 3 dimensional camera following two-jaw rotational orthognathic surgery in skeletal class III patients. J Craniomaxillofac Surg. 2014 Apr;42(3):220-6. doi: 10.1016/j.jcms.2013.05.004. Epub 2013 Jul 17.
13-Wang Z, Wang P, Zhang Y, Shen G. Nasal Airway Evaluation After Le Fort I Osteotomy Combined With Septoplasty in Patients With Cleft Lip and Palate. J Craniofac Surg. 2017 Jan;28(1):207-211. doi: 10.1097/SCS.0000000000003259.
14- Keller EE, Sather AH. Quadrangular Le Fort I osteotomy: Surgical technique and review of 54 patients. Journal of oral and maxillofacial surgery. 1990 Jan 1;48(1):2-11
15-San Miguel Moragas J, Van Cauteren W, Mommaerts MY. A systematic review on soft-to-hard tissue ratios in orthognathic surgery part I: maxillary repositioning osteotomy. J Craniomaxillofac Surg. 2014 Oct;42(7):1341-51. doi: 10.1016/j.jcms.2014.03.024. Epub 2014 May 21.
16-Naini FB, Cobourne MT, McDonald F, Wertheim D3. The aesthetic impact of upper lip inclination in orthodontics and orthognathic surgery. Eur J Orthod. 2015 Feb;37(1):81-6. doi: 10.1093/ejo/cju015. Epub 2014 Jul 12.
17-Naini FB, Gill DS, editors. Orthognathic surgery: principles, planning and practice. John Wiley & Sons; 2017 Feb 6.
18- Ghassemi M, Hilgers RD, Jamilian A, Shokatbakhsh A, Hölzle F, Fritz U,et al. Effect of maxillary advancement on the change in the soft tissues after treatment of patients with class III malocclusion. Br J Oral Maxillofac Surg. 2015 Oct;53(8):754-9. doi: 10.1016/j.bjoms.2015.06.001. Epub 2015 Jun 26.
19-Hoffman GR, Brennan PA. The skeletal stability of one-piece Le Fort 1 osteotomy to advance the maxilla; Part 2. The influence of uncontrollable clinical variables. Br J Oral Maxillofac Surg. 2004 Jun;42(3):226-30.
20-Costa F, Robiony M, Zorzan E, Zerman N, Politi M. Stability of skeletal Class III malocclusion after combined maxillary and mandibular procedures: titanium versus resorbable plates and screws for maxillary fixation. J Oral Maxillofac Surg. 2006 Apr;64(4):642-51.
21-Liebregts J1, Xi T, Timmermans M, de Koning M, Bergé S, Hoppenreijs T, et al. Accuracy of three-dimensional soft tissue simulation in bimaxillary osteotomies. J Craniomaxillofac Surg. 2015 Apr;43(3):329-35. doi: 10.1016/j.jcms.2014.12.012. Epub 2014 Dec 30.
22- Abdolreza Jamilian. Tracing technique and Landmark recognition .In: Principles of Cephalometric Tracing. Abdolreza Jamilian .Tehran: Shayan Nemoudar; 2016.
23-Azamian Z, Shirban F. Treatment Options for Class III Malocclusion in Growing Patients with Emphasis on Maxillary Protraction. Scientifica (Cairo). 2016;2016:8105163. doi: 10.1155/2016/8105163. Epub 2016 Apr 10
24-Ghassemi M, Ghassemi A, Showkatbakhsh R, Ahmad SS, Shadab M, Modabber A, et al. Evaluation of soft and hard tissue changes after bimaxillary surgery in class III orthognathic surgery and aesthetic consideration. Natl J Maxillofac Surg. 2014 Jul-Dec;5(2):157-60. doi: 10.4103/0975-5950.154819.
25-Oltramari-Navarro PV, de Almeida RR, Conti AC, Navarro Rde L, de Almeida MR, Fernandes LS. Early treatment protocol for skeletal Class III malocclusion. Braz Dent J. 2013;24(2):167-73. doi: 10.1590/0103-6440201301588.
26-Nagori H, Fattahi T. Maxillary advancement surgery and nasolabial soft tissue changes. J Medical and Dental Sciences. 2017;16:23-9.
27-Marşan G, Cura N, Emekli U. Soft and hard tissue changes after bimaxillary surgery in Turkish female Class III patients. J Craniomaxillofac Surg. 2009 Jan;37(1):8-17. doi: 10.1016/j.jcms.2008.07.004. Epub 2008 Sep 10.
28-Vasudavan S, Jayaratne YS, Padwa BL. Nasolabial soft tissue changes after Le Fort I advancement. J Oral Maxillofac Surg. 2012 Apr;70(4):e270-7. doi: 10.1016/j.joms.2011.11.022. Epub 2012 Jan 28.
29-Freihofer P. The lip profile after correction of retromaxillarism in cleft and non-cleft patients. J Maxillofac Surg 1976: 4: 136-41.
30-Mansour S, Burstone C, Legan H. An evaluation of soft-tissue changes resulting from Le Fort I maxillary surgery. Am J Orthod. 1983 Jul;84(1):37-47.
31-Gassmann CJ, Nishioka GJ, Van Sickels JE, Thrash WJ. A lateral cephalometric analysis of nasal morphology following Le Fort I osteotomy applying photometric analysis techniques. J Oral Maxillofac Surg. 1989 Sep;47(9):926-30.
32-Tiwari R, Chakravarthi PS, Kattimani VS, Lingamaneni KP. A Perioral Soft Tissue evaluation after Orthognathic Surgery Using Three-Dimensional Computed Tomography Scan. Open Dent J. 2018; 12: 366–376.
33-Rosen HM. Lip-nasal aesthetics following Le Fort I osteotomy. Plast Reconstr Surg. 1988 Feb;81(2):171-82.
34-Fernández-Riveiro P, Smyth-Chamosa E, Suárez-Quintanilla D, Suárez-Cunqueiro M. Angular photogrammetric analysis of the soft tissue facial profile. Eur J Orthod. 2003 Aug;25(4):393-9.
35-Rustemeyer J, Martin A. Soft tissue response in orthognathic surgery patients treated by bimaxillary osteotomy: cephalometry compared with 2-D photogrammetry. Oral Maxillofac Surg. 2013 Mar;17(1):33-41. doi: 10.1007/s10006-012-0330-0. Epub 2012 May 5.
36-Ragaey M, Van Sickels JE. Stability of large maxillary advancements using a combination of prebent and conventional plates for fixation. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Jan;123(1):29-36. doi: 10.1016/j.oooo.2016.08.019. Epub 2016 Sep 21.
37- Koerich L, Brunetto DP, Ohira ETB. The effect of hard tissue surgical changes on soft tissue displacement: a pilot CBCT study. Dental Press J Orthod. 2017 Sep-Oct;22(5):39-46. doi: 10.1590/2177-6709.22.5.039-046.oar.
38-Tseng YC, Cheng JH, Chen MY, Chen KJ, Chen CM. The changes of cheek line (lateral) and face line (frontal) after correction of mandibular prognathism. BioMed research international. 2018;2018.
| Files | ||
| Issue | Vol 6, No 1 (Winter 2019) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jcr.v6i1.1629 | |
| Keywords | ||
| Esthetics Conventional Le Fort I osteotomy Face High level Le Fort I osteotomy Maxillary advancement | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Foroughi R, Khakbaz O, Maneshi M. Middle and lower facial soft tissue changes after maxillary advancement through conventional or high Le Fort I osteotomy. J Craniomaxillofac Res. 2019;6(1):39-50.
