The Effects of Maxillary Movements on Nasal Aesthetics Following Orthognathic Surgery

Abstract

Improvement of the harmony between facial subunits is the ultimate goal of orthognathic surgery and surgeons must accurately make soft tissue projections for planned bony movements. Yet, few studies have examined the effects’ of orthognathic surgery on aesthetic parameters of nasolabial area on a thorough basis. This retrospective study included 61 patients that underwent orthognathic surgery. Demographic data, evaluation period, and surgical details were analyzed. Superficial topographical analysis of intercanthal distance, alar width, nasal height, nasal length, nasal tip protrusion, upper lip height, nasal bone angle, supratip break angle, nasal dorsum angle, nasal tip angle, columellar-lobular angle, columellar-labial angle, upper lip angle, and tip-to-midline angle was recorded before and after surgery. Postoperative changes in these parameters and their correlation to maxillary movements were analyzed. Alar width, upper lip height, columellar-labial angle, supratip break angle, nasal dorsum angle, and upper lip angle increased postsurgery, whereas tip-to-midline angle decreased. Upper lip height and columellar-labial angle were significantly correlated with clockwise/counter-clockwise rotation and anterior re-positioning. Columellar-labial angle increased 2° for each 1 mm of anterior movement and decreased 4° for each 1 mm of counter-clockwise rotation. Novel parameters, such as columellar-lobular angle and tip-to-midline angle, were not associated with any maxillary movement postsurgery. Orthognathic surgery primarily affected the lower third of the nose and changed alar width, upper lip height, supratip break angle, nasal dorsum angle, columellar-labial angle, upper lip angle, and tip-to-midline angle in this region; however, only columellar-labial angle and upper lip height were found to be correlated solely with maxillary movements.

The Rhino-Lip-Lifting: A Novel Proposal for Midface Profileplasty Performed as a Single Surgical Procedure

“…Open or closed rhinoplasty can thus be combined with liplift, as previously reported, with both cutaneous and endonasal incision, as the chance to perform multiple surgical corrections during a single operating session is of great benefit for both the patient and the surgeon. 36 The major concern about one or two incisions, along with the fear of columellar necrosis, is no longer the case since several authors confirmed the safety of both approaches and that the scar is no longer visible after a proper healing period (►Figs. 14-16).…”

“…Outcomes of lip shortening and NLA widening recorded in the study population have here been presented as a percentage since authors believe that direct linear measurements are not paramount when assessing facial proportions, as their variability is found in multiple papers. 2,3,12,20,25,31,36 Finally, the described procedure's aim is to rejuvenate the lip through its shortening. Patients, however, mostly appreciate lip eversion and projection along with the perception of an increased fullness.…”

Analysis of Gull in Flight Appearance and Related Parameters Following Le Fort I Osteotomy

“…Although there are many studies about the effect of maxillary movements on soft tissue, very few of these studies provide specific information about the change in nasal morphology. 6,7,16,18,20 In this study, how ''Gull in Flight'' appearance is affected postoperatively was investigated together with other specific parameters related with nasal aesthetics.…”

“…22 There were a few studies in the literature examining the relation of the columella lobular angle with maxillary movements. 16,18,23 Gencay et al 18 stated columella lobular angle was increased following maxillary impaction, advancement, and rotation but inferior position of maxilla decreased this angle. However, these changes were not found statistically significant.…”

“…There were a few studies about columella and columella-alar relationship in the literature. 8,18 There are still questions need to be explained about how maxillary surgery affects the columella. In our knowledge, there has been no study in the literature about how the ''Gull in Flight'' appearance be affected from maxillary movements.…”