Effect of Le Fort I Maxillary Advancement and Clockwise Rotation on the Anteromedial Cheek Soft Tissue Change in Patients with Skeletal Class III Pattern and Midface Deficiency: A 3D Imaging-Based Prediction Study

Abstract

Patients with a skeletal Class III deformity may present with a concave contour of the anteromedial cheek region. Le Fort I maxillary advancement and rotational movements correct the problem but information on the impact on the anteromedial cheek soft tissue change has been insufficient to date. This three-dimensional (3D) imaging-assisted study assessed the effect of surgical maxillary advancement and clockwise rotational movements on the anteromedial cheek soft tissue change. Two-week preoperative and 6-month postoperative cone-beam computed tomography scans were obtained from 48 consecutive patients who received 3D-guided two-jaw orthognathic surgery for the correction of Class III malocclusion associated with a midface deficiency and concave facial profile. Postoperative 3D facial bone and soft tissue models were superimposed on the corresponding preoperative models. The region of interest at the anteromedial cheek area was defined. The 3D cheek volumetric change (mm3; postoperative minus preoperative models) and the preoperative surface area (mm2) were computed to estimate the average sagittal movement (mm). The 3D cheek mass position from orthognathic surgery-treated patients was compared with published 3D normative data. Surgical maxillary advancement (all p < 0.001) and maxillary rotation (all p < 0.006) had a significant effect on the 3D anteromedial cheek soft tissue change. In total, 78.9%, 78.8%, and 78.8% of the variation in the cheek soft tissue sagittal movement was explained by the variation in the maxillary advancement and rotation movements for the right, left, and total cheek regions, respectively. The multiple linear regression models defined ratio values (relationship) between the 3D cheek soft tissue sagittal movement and maxillary bone advancement and rotational movements of 0.627 and 0.070, respectively. Maxillary advancements of 3–4 mm and >4 mm resulted in a 3D cheek mass position (1.91 ± 0.53 mm and 2.36 ± 0.72 mm, respectively) similar (all p > 0.05) to the 3D norm value (2.15 ± 1.2 mm). This study showed that both Le Fort I maxillary advancement and rotational movements affect the anteromedial cheek soft tissue change, with the maxillary advancement movement presenting a larger effect on the cheek soft tissue movement than the maxillary rotational movement. These findings can be applied in future multidisciplinary-based decision-making processes for planning and executing orthognathic surgery.

3-dimensional analysis of nasal soft tissue alterations following maxillary Lefort I advancement with and without impaction using 3D photogrammetry scanner

“…Similar to the present study, Foroughi et al reported no significant difference in NLA after maxillary advancement only based on cephalometric evaluation also, they trimmed the ANS in contrast to our study [ 26 ]. Conversely, Lai et al reported a significant increase in NLA after maxillary advancement and clockwise rotation and without trimming ANS similar to this study [ 33 ]. On the other hand, Nagori et al and Marsan et al reported a decrease in NLA by cephalometric evaluation after maxillary advancement [ 34 , 35 ].…”

The Midfacial Soft Tissue Changes After Anterior Maxillary Segmental Distraction Osteogenesis in Patients With Cleft: A 3-Dimensional Volumetric-Based Subunit Analysis

“…To the best of our knowledge, no previous study has explored the difference in soft tissue changes after AMSDO between the cleft side and the noncleft side. In a previous study, the cheek soft tissue changes after cleft orthognathic surgery on the cleft was different from that on the noncleft side 16. However, we found no significant difference in the midfacial region on both sides.…”

Digitale Weichteilvorhersage im Kontext der kieferorthopädisch-kieferchirurgischen Behandlung

“…Ein Faktor von 1 entspricht dabei einer gleichwertigen Verlagerung von Weich-und Hartgewebe, während kleinere Werte eine geringere Veränderung des Weichgewebes gegenüber der knöchernen Basis bedeuten. Für sämtliche fazialen Regionen konnte in diesem Zusammenhang ein Verlagerungsfaktor von < 1 ermittelt werden, wobei die die größte Korrelation zwischen Hart-und Weichgewebsveränderung im Bereich des Kinns festgestellt werden konnte [11,12]. Konkret wurde im Bereich der Oberlippe ein Verlagerungsfaktor bei 0,78 und für die Unterlippe bei 0,77 beschrieben, hingegen für die Nasenspitze und -basis ein Wert von 0,74 bzw.…”

“…Konkret wurde im Bereich der Oberlippe ein Verlagerungsfaktor bei 0,78 und für die Unterlippe bei 0,77 beschrieben, hingegen für die Nasenspitze und -basis ein Wert von 0,74 bzw. 0,70 [12]. Für die Wangen ist ein Faktor von 0,73 und für das Kinn von 0,94 bekannt [11,12].…”

“…0,70 [12]. Für die Wangen ist ein Faktor von 0,73 und für das Kinn von 0,94 bekannt [11,12]. Dies verdeutlicht, dass aufgrund der regionalen Unterschiede des fazialen Weichgewebes, eine Patienten-spezifische Vorhersage der möglichen Weichgewebsveränderung nicht präzise stattfinden kann.…”