The Impact on Nasal Septal Anatomy and Physiology Following Le Fort I Osteotomy for Orthognathic Surgery

Abstract

Orthognathic surgery utilizing a Le Fort I osteotomy is performed by oral and maxillofacial surgeons to correct midface and dental occlusal abnormalities. However, the potential sequelae on sinonasal function have had minimal discussion in the literature. The objective of this study was to assess the impact on nasal septum anatomy and physiology following Le Fort I osteotomy for maxillary repositioning surgery. Thirty patients who previously underwent elective orthognathic surgery with Le Fort I osteotomy were enrolled retrospectively to assess the change in their nasal septal anatomy and nasal breathing. Pre- and postoperative computed tomography (CT) scans were used to determine axial displacement of the septum, in both degrees and millimeters, at 4 different standardized anatomic sites following the surgery. These objective anatomic measurements were then compared to the patient's perception of nasal congestion and difficulty breathing via the validated Chronic Sinusitis Survey-Duration Based (CSS-D). Comparison of the CTs before and after surgery demonstrated a new deviation of the nasal septum in all 30 patients, with maximal axial displacements up to 7.22 mm and a mean of 2.64 mm. Postoperative angular displacement changes ranged from minimal to 24°. The CTs showed persistence of a new septal perforation in 20% (6 of 30 patients) following surgery. The CSS-D results demonstrated a mean worsening of nasal breathing and congestion scores from 1.4 before surgery to 3.0 at least 8 weeks after surgery (P < 0.001). Orthognathic surgery utilizing Le Fort I osteotomy may result in persistent nasal septal perforations, new displacement of the nasal septum, and increased perception of nasal dyspnea not previously reported. Further understanding of anatomic changes and nasal airway obstruction that may be caused following such operations warrants further study in order to improve surgical technique and postoperative outcomes.

The Effect of Trans-Sutural Distraction Osteogenesis on Nasal Bone, Nasal Septum, and Nasal Airway in the Treatment for Midfacial Hypoplasia in Growing Patients

“…In previous studies, it was found that surgery to correct midfacial dysplasia may affect the nasal septum and nasal airway. Traditional Le Fort osteotomy can increase the nasal airway volume and reduce the total nasal resistance, 30 but is associated with a risk of nasal septum perforation 31 . Le Fort I-DO can also increase the nasal also airway volume 32 .…”

“…Traditional Le Fort osteotomy can increase the nasal airway volume and reduce the total nasal resistance, 30 but is associated with a risk of nasal septum perforation. 31 Le Fort I-DO can also increase the nasal also airway volume. 32 These studies suggest that surgery to correct midfacial dysplasia can play a role in improving nasal airway stenosis, which is similar to our findings.…”