Three-Dimensional Nasal Alterations in Le Fort I Advancement: Linear Measurements, Angles, Nasal Indices, and Volume Differences

Abstract

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.

Analysis of Inferior Nasal Morphology and Nostrils following Le Fort I Osteotomy

“…Many studies reported that the amount of maxillary movement affects these parameters, and these parameters were mainly analyzed from profile and frontal views. 4,8,13 Although the bottom view is not always seen during social interaction, the head's movement while smiling, drinking, or eating makes this view visible. With selfie photography by smartphones and social media taking their place in our daily lives, the bottom view of the nose has gained importance for evaluating the nose.…”

“…There have been many parameters such as alar width, alar base width, nostril shape, and columella length related to inferior nasal area aesthetic. Many studies reported that the amount of maxillary movement affects these parameters, and these parameters were mainly analyzed from profile and frontal views 4,8,13. Although the bottom view is not always seen during social interaction, the head’s movement while smiling, drinking, or eating makes this view visible.…”

“…7 Also, other morphologic studies evaluate nostril shapes among races. 5,8 Following orthognathic surgery, inferior nasal morphology, nostril shapes, and nostrils according to Modified Topinard System have not been evaluated previously.…”

“…In 1983, according to Modified Topinard System, nostrils were classified into 7 types with respect to the angle between the longitudinal axis of the left and right nostril, and it was stated that nostril types are different among races 7. Also, other morphologic studies evaluate nostril shapes among races 5,8. Following orthognathic surgery, inferior nasal morphology, nostril shapes, and nostrils according to Modified Topinard System have not been evaluated previously.…”

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

“…[3][4][5] In the literature, there have been many studies about impact of skeletal changes on nasal region following maxillary surgery and these studies mainly focused on parameters such as nasal tip, paranasal soft tissue projection, and alar width. [5][6][7][8][9] Results of these studies contribute to make an algorithm between hard tissue and soft tissue projection for virtual 3D computer aided planning systems for orthognathic surgery. Virtual surgical planning and rapid prototyping technology provide new possibilities for a comprehensive 3D evaluation of dental arches and skeletal structures to simulate different surgical plans and predict relevant outcomes.…”