The maxillary advancement obtained by the Le Fort I osteotomy can also generate significant changes in the soft tissue of the nose and lips. The aim of this study was to compare the alterations in the soft tissue of the nose following the Le Fort I osteotomy maxillary advancement technique in a population of young adults submitted to orthognathic surgery. Seven men and 8 women aged between 23 and 45 underwent orthognathic surgery using the Le Fort I osteotomy and bilateral mandibular sagittal osteotomy. Sixty 3-dimensional images were analyzed (Vectra M3, Canfield, NJ) after labeling landmarks on the face and determining linear and angular measurements, proportion, and volume difference indices at the following intervals: preoperatively (baseline), then 2 months, 6 months, and 1 year after surgery. Following Le Fort I, there was an increase in the alar base, and reduction of nasal tip protrusion, nasal angles, and the nasal tip protrusion index (P < 0.05). There were no differences in the facial thirds, the nasal index, and angles of nasal and mentolabial convexity (P > 0.05). There was a difference in the volume of the nose only 2 months after surgery. The Le Fort I osteotomy caused significant alterations in linear, angular, and nasal proportion measurements. The volume differences were reversible in the early postoperative period and probably associated with edema. The possibility of variations in the size and shape of the nose should be presented to prospective patients preoperatively.
The purpose of this study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) investigating the efficacy of hilotherapy on postoperative pain, swelling, neurosensory impairment and patient satisfaction. The authors analyzed RCTs comparing the use of hilotherapy versus conventional cryotherapy or no cold treatment for orthognathic surgery and repair of facial trauma. The authors assessed the risk of bias and strength of evidence according to the Cochrane guidelines and GRADE rating system, respectively. Treatment effects were defined as weighted or standardized mean difference using the inverse variance method. Five RCTs were included. Postoperative pain and swelling in patients using hilotherapy were lower comparing to the control group in the postoperative day 2 (Pain: MD −1.75, CI 95% −2.69 to −0.81; Swelling: MD −21.16 mL, CI 95% −38.91 to −3.41) and in the final evaluation (Pain: MD −0.31, CI 95% −0.44 to −0.18; MD −4.45 mL, CI 95% −7.87 to −1.03). Patients reported higher satisfaction with hilotherapy, but no differences were found for neurosensory impairment. Current evidence suggests that hilotherapy is effective in reducing postoperative pain and swelling in orthognathic surgery and repair of facial fractures and may lead to improvements in patient satisfaction in the recovery phase.
The purpose of this retrospective study was to determine postoperative volume differences associated with orthognathic surgery after controlling for time, gender, age, and side of face. Three-dimensional (3D) photographs of 10 patients submitted to simultaneous Le Fort I + Bilateral Sagittal Split osteotomies were analyzed. The images were obtained using a Vectra® M3 device (Canfield, NJ, USA) and were captured postoperatively, at 1 week (1S), 1 month (1M), 2 months (2M), 6 months, (6M) and 1 year (1A). The photo taken at 1A was used as the basis of comparison for the other photos (1S, 1M, 2M, and 6M). Greatest facial volume was observed at 1 week after surgery (42.54 cm3, SD = 29.71 cm3), with men in this period showing higher values (60.20 cm3, SD = 36.75 cm3) than women (30.76 cm3, SD = 19.04 cm3). The most extensive facial volume reduction occurred between the first week and the first month; postoperatively (52.1%). No significant difference was found between age and side groups.
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