Evaluation of facial aesthetics by laypersons in patients undergoing intraoral quadrangular Le Fort II osteotomy compared with conventional Le Fort I osteotomy

Abstract

In this study we compared the aesthetic outcome of (1) Le Fort I (LFI) osteotomy and (2) intraoral quadrangular Le Fort II (IQLFII) osteotomy for surgical correction of skeletal class III dysgnathia involving midfacial deficiency. The aim was to investigate whether laypersons see differences in facial changes that occur due to variations of the osteotomy cuts. The patient collectives consisted of 23 patients in each group. Pre-and postoperative photographs were presented in a random sequence to 40 layperson raters. The rating procedure was conducted with a four-point Likert scale. Assessed characteristics were 'attractiveness' ('Attraktivität'), 'likeability' ('Sympathie'), 'intelligence' ('Intelligenz'), 'aggressiveness' ('Aggressivität') and 'dominance' ('Dominanz'). For preoperative photographs we found a significant difference for 'likeability' with lower ratings for the IQLFII group; all other criteria were rated similarly. For the IQLFII group we found a significantly larger shift from lower to higher ratings for 'attractiveness' and 'likeability' and a significantly larger shift from higher to lower ratings for 'aggressiveness' and 'dominance' than for the LF I group. Our study shows that lay raters detect significant differences between the two surgical groups. Thus, IQLFII osteotomy, when indicated, represents a favourable alternative to conventional LFI osteotomy, if patients desire the expectable change in recognition by their social circle.

Vertical Bonegraft Wrap—A Technique to Increase Soft Tissue Volume in Paranasal Region

“…In some surgical movements, the repercussion of soft tissue is needed to correct the patient’s paranasal deficiency, however, in some cases, even after extensive maxillary advancements, the patient may still present a midface deficiency. Therefore, some techniques can be considered an acceptable method for the correction of this condition including quadrangular Le Fort I osteotomy, quadrangular Le Fort II osteotomy, or even high Le Fort I osteotomies 7,8. However, these procedures had limited versatility and required ideal anatomy of the patient.…”

“…Therefore, some techniques can be considered an acceptable method for the correction of this condition including quadrangular Le Fort I osteotomy, quadrangular Le Fort II osteotomy, or even high Le Fort I osteotomies. 7,8 However, these procedures had limited versatility and required ideal anatomy of the patient. Another treatment option for this situation is using grafting materials over osteotomized segments to gain volume for soft tissues.…”

“…Even with extensive advancements, the paranasal region remains deficient due to a 60% repercussion rate of bone movement in soft tissues, 6 which demonstrates the need, in many cases, of using concomitant techniques to gain volume in the middle third of the face. Some techniques have tried to improve the volume in this region by using modified quadrangular Le fort I osteotomy, quadrangular Le fort II osteotomy, or even higher Le Fort I osteotomies, 7,8 however, to date, there is no technique in the literature to increase soft tissue support in the paranasal region concomitant to bone grafting in orthognathic surgery. Thus, this study aimed to present a technique of vertical bonegraft wrap, a modified technique proposed by Klüppel et al, 9 to increase soft tissue volume in the maxilla after Le Fort I osteotomy in a patient with severe paranasal deficiency and midfacial hypoplasia.…”

A Narrative Review of Eye-Tracking Assessment of Esthetic Endpoints in Plastic, Reconstructive, and Craniofacial Surgery

“…When changes are very subtle, it certainly cannot be a dependable and reliable tool for comparison. 10,11 Furthermore, similar to all other questionnaire-based investigations, judgment by untrained laypersons rater groups suffer from many limitations, including a basic bias tendency among raters and highly subjective views of beauty. 1,11,12 Since the notion of beauty and attractiveness is traditionally viewed to be in the "eye of the beholder," and beauty appreciation is a perception of the physical form that the visual processing segment of the nervous system finds attractive, measuring human perception by eye-tracking (ET) technology has emerged recently as a reasonable advanced tool for objective esthetic outcome assessment of interventions.…”

“…10,11 Furthermore, similar to all other questionnaire-based investigations, judgment by untrained laypersons rater groups suffer from many limitations, including a basic bias tendency among raters and highly subjective views of beauty. 1,11,12 Since the notion of beauty and attractiveness is traditionally viewed to be in the "eye of the beholder," and beauty appreciation is a perception of the physical form that the visual processing segment of the nervous system finds attractive, measuring human perception by eye-tracking (ET) technology has emerged recently as a reasonable advanced tool for objective esthetic outcome assessment of interventions. 1,13,14 The current review is intended to analyze available evidence regarding the advantages as well as limitations of this technology in objectively documenting outcome of medical or surgical plastic, reconstructive, and craniofacial procedures.…”