Int J Stomatol

Int J Stomatol ›› 2023, Vol. 50 ›› Issue (3): 293-301.doi: 10.7518/gjkq.2023028

• Original Articles • Previous Articles     Next Articles

Soft tissue changes of the maxillary region in patients after anterior maxillary osteotomy setback and Le Fort Ⅰ osteotomy advancement

Li Peiran(),Bi Ruiye,Wang Min,Wang Ruiyu,Liu Yao,Jiang Nan,Cao Pinyin,Zhu Songsong.()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthognathic and Temporomandibular Joint Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2022-08-07 Revised:2023-01-06 Online:2023-05-01 Published:2023-05-16
  • Contact: Songsong. Zhu E-mail:peiran_li@foxmail.com;Zss_1977@163.com
  • Supported by:
    National Natural Science Foundation of China(81801003);New Technology Project of West China Hospital of Stomatology, Sichuan University(LCYJ2020-YF-1)

RichHTML

23

PDF (PC)

290

Abstract:

Objective This work aimed to analyze nasolabial soft tissue changes in patients with maxillary advancement and setback via different maxillary orthognathic procedures. Methods A retrospective, observational, and analytical study was carried out for a period of 4 years involving 37 patients. A total of 18 patients diagnosed with maxillary retrusion were treated by Le Fort Ⅰ osteotomy advancement (LFIA), and 19 patients diagnosed with maxillary protrusion were treated by anterior maxillary osteotomy setback (AMOS). Similarity and distinction of soft tissue changes in these two groups (AMOS and LFIA) were investigated and compared. Spiral computed tomography was conducted immediately before surgery and 6-12 months after surgery. The hard and soft tissue landmarks were measured in a 3D coordinate system after CT reconstruction. The differences between pre- and postoperative images were recorded as surgical changes. The appropriate statistical test was carried using GraphPad Prism, and the level of significance was α=0.05. Results Both LFIA and AMOS brought greater soft tissue changes in the lip region compared with those in the nose and cheek regions. In the anteroposterior direction, the hard/soft tissue change ratio after LFIA (0.628) was higher than that after AMOS (0.465). Cheek and nose tips protruded after both surgical processes. Ck advancement was significantly correlated with soft tissue thickness change in the AMOS group. In the vertical direction, Prn presented uplift movement that was correlated with the maxilla advancement distance in the LFIA group, whereas Ls showed downward movement that was correlated with the maxilla setback distance in the AMOS group. Postoperative alar width increased in both groups. Interestingly, the degree of alar widening was negatively correlated with the maxilla setback distance in the AMOS group. Conclusion Postoperative nasolabial soft tissue changes in both LFIA and AMOS patients could be predicted through the direction and amount of maxilla movement to a large extent, especially in the lip region. Further investigations to illustrate the precise correlations between soft tissue changes and maxillary movement in the future could be beneficial for the prediction of postoperative appearance.

Key words: soft tissue, dentofacial deformity, Le Fort Ⅰ osteotomy, anterior maxillary osteotomy, orthognathic surgery

CLC Number: 

  • R 782.2+3

TrendMD: 

Tab 1

The information of included subjects"

测量项目总体AMOS组LFIA组
病例数/例371918
性别/例男1138
女261610
年龄/岁24.0±4.826.7±4.821.2±2.6
术式/例单上颌手术532
联合下颌升支矢状劈开术16016
联合下颌前份根尖下截骨术16160
联合颏成形术15123

Fig 1

The superimposition of pre- and post-operative CT reconstructed image"

Tab 2

The description of landmarks on soft and hard tissue"

测量标志缩写说明
鼻根点Na位于面中线上的鼻额缝投影点，用于表示鼻根位置
鼻尖点Prn鼻尖最凸点
鼻下点Sn位于面中线上的鼻小柱与上唇交界点
上唇缘点Ls位于面中线上的上唇唇红上缘点
鼻翼点Al正面观双侧鼻翼轮廓最凸点
鼻基底点Sbal双侧鼻翼向下至与上唇皮肤移行处的标志点
颊点Ck口角-外眦连线与过双侧鼻翼点的直线的交点位于面颊软组织的投影点
口裂点Ch双侧口裂缘点
鼻翼宽度Al-Al双侧鼻翼点间连线的距离
鼻基底宽度Sbal-Sbal双侧鼻基底点间连线的距离
上唇宽度Ch-Ch双侧口裂点间连线的距离
上齿槽缘点Prs位于面中线上的上颌牙槽突最凸点
上齿槽座点A位于面中线上的，由前鼻棘点至上齿槽缘点之间上颌骨体最凹处的标志点
尖牙牙槽缘点Cn双侧上颌尖牙牙槽骨的颈缘最凹点

Fig 2

The location of landmarks on soft and hard tissue"

Tab 3

Soft tissue changes in anteroposterior direction mm"

测量项目LFIA组AMOS组
平均值标准差平均值标准差
Na-0.030.400.060.50
Prn1.390.400.420.36
Sn2.570.75-0.190.63
Ls3.491.13-2.620.91
Ck_R1.830.651.310.74
Ck_L1.830.771.270.67

Tab 4

The soft tissue changes in vertical direction mm"

测量项目LFIA组AMOS组
平均值标准差平均值标准差
Na-0.271.04-0.311.09
Prn1.631.310.001.00
Sn1.030.80-0.270.70
Ls0.011.92-2.131.75

Tab 5

The width changes of soft tissue landmarks mm"

测量项目LFIA组AMOS组
平均值标准差平均值标准差
Al-Al2.171.281.650.81
Sbal-Sbal1.791.45-0.831.06
Ch-Ch-0.572.68-1.852.57

Tab 6

The thickness changes in different soft tissue landmarks"

测量项目LFIA组AMOS组
平均值标准差平均值标准差
Ls-0.041.491.630.91
Sn-0.432.123.171.21
Ck_R0.920.921.130.73
Ck_L0.901.150.840.82
Al_R2.341.221.791.02
Al_L2.740.811.820.83

Fig 3

Association between maxilla movements and soft tissue changes in anteroposterior direction"

Fig 4

Association between maxilla movements and soft tissue changes in vertical direction"

Fig 5

Association between maxilla setback and alar width change in AMOS group"

Fig 6

Association between soft tissue thickening and cheek point advancement in AMOS group"

"

1 Posnick JC. Orthognathic surgery: principles and practice[M]. Saunders: St. Louis, Missouri, 2014: 61-68.
2 Lo LJ, Weng JL, Ho CT, et al. Three-dimensional region-based study on the relationship between soft and hard tissue changes after orthognathic surgery in patients with prognathism[J]. PLoS One, 2018, 13(8): e0200589.
3 Aydil B, Özer N, Marşan G. Bimaxillary surgery in Class Ⅲ malocclusion: soft and hard tissue changes[J]. J Craniomaxillofac Surg, 2013, 41(3): 254-257.
4 Becker OE, Avelar RL, Dolzan ADON, et al. Soft and hard tissue changes in skeletal Class Ⅲ patients treated with double-jaw orthognathic surgery-maxillary advancement and mandibular setback[J]. Int J Oral Maxillofac Surg, 2014, 43(2): 204-212.
5 Park JH, Jung HD, Cha JY, et al. Hard and soft tissue changes and long-term stability after vertical height reduction genioplasty using biodegradable fixation[J]. Int J Oral Maxillofac Surg, 2019, 48(8): 1051-1056.
6 Park JY, Kim MJ, Hwang SJ. Soft tissue profile changes after setback genioplasty in orthognathic surgery patients[J]. J Cranio Maxillofac Surg, 2013, 41(7): 657-664.
7 Kim KA, Chang YJ, Lee SH, et al. Three-dimensional soft tissue changes according to skeletal changes after mandibular setback surgery by using cone-beam computed tomography and a structured light scanner[J]. Prog Orthod, 2019, 20(1): 25.
8 Bhagat SK, Kannan S, Babu MRR, et al. Soft tissue changes following combined anterior segmental bimaxillary orthognathic procedures[J]. J Maxillofac Oral Surg, 2019, 18(1): 93-99.
9 Okudaira M, Kawamoto T, Ono T, et al. Soft-tissue changes in association with anterior maxillary osteotomy: a pilot study[J]. Oral Maxillofac Surg, 2008, 12(3): 131-138.
10 Storms AS, Miclotte A, Grosjean L, et al. Short-term hard and soft tissue changes after mandibular advancement surgery in Class Ⅱ patients: a retrospective cephalometric study[J]. Eur J Orthod, 2017, 39(5): 567-576.
11 Jung J, Lee CH, Lee JW, et al. Three dimensional evaluation of soft tissue after orthognathic surgery[J]. Head Face Med, 2018, 14(1): 21.
12 Vasudavan S, Jayaratne YSN, Padwa BL. Nasolabial soft tissue changes after Le Fort Ⅰ advancement[J]. J Oral Maxillofac Surg, 2012, 70(4): e270-e277.
13 Worasakwutiphong S, Chuang YF, Chang HW, et al. Nasal changes after orthognathic surgery for patients with prognathism and Class Ⅲ malocclusion: analysis using three-dimensional photogrammetry[J]. J Formos Med Assoc, 2015, 114(2): 112-123.
14 Akan B, Gökçe G, Karadede Ünal B, et al. Assessment of soft tissue changes after LeFort Ⅰ advancement[J]. Eur Arch Otorhinolaryngol, 2021, 278(3): 813-819.
15 Freihofer HP Jr. The lip profile after correction of retromaxillism in cleft and non-cleft patients[J]. J Maxillofac Surg, 1976, 4: 136-141.
16 Kau CH, Cronin AJ, Richmond S. A three-dimensional evaluation of postoperative swelling following orthognathic surgery at 6 months[J]. Plast Reconstr Surg, 2007, 119(7): 2192-2199.
17 Tiwari R, Chakravarthi PS, Kattimani VS, et al. A perioral soft tissue evaluation after orthognathic surgery using three-dimensional computed tomography scan[J]. Open Dent J, 2018, 12: 366-376.
18 Cevidanes LH, Motta A, Proffit WR, et al. Cranial base superimposition for 3-dimensional evaluation of soft-tissue changes[J]. Am J Orthod Dentofacial Orthop, 2010, 137(4 ): S120-S129.
19 Dong Y, Zhao YM, Bai SZ, et al. Three-dimensional anthropometric analysis of Chinese faces and its application in evaluating facial deformity[J]. J Oral Maxillofac Surg, 2011, 69(4): 1195-1206.
20 Farkas LG. Anthropometry of the head and face[M]. New York: Raven Press, 1994.
21 Ferrario VF, Sforza C, Serrao G, et al. Soft tissue facial growth and development as assessed by the three-dimensional computerized mesh diagram ana-lysis[J]. Am J Orthod Dentofacial Orthop, 1999, 116(2): 215-228.
22 Soncul M, Bamber MA. Evaluation of facial soft tissue changes with optical surface scan after surgical correction of Class Ⅲ deformities[J]. J Oral Maxillofac Surg, 2004, 62(11): 1331-1340.
23 Alkadhi RM, Finkelman MD, Trotman CA, et al. The role of lip thickness in upper lip response to sagittal change of incisor position[J]. Orthod Craniofac Res, 2019, 22(1): 53-57.
24 Hodgkinson D, Firth FA, Farella M. Effect of incisor retraction on facial aesthetics[J]. J Orthod, 2019, 46(): 49-53.
25 Kim M, Lee DY, Lim YK, et al. Three-dimensional evaluation of soft tissue changes after mandibular setback surgery in Class Ⅲ malocclusion patients according to extent of mandibular setback, vertical skeletal pattern, and genioplasty[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology, 2010, 109(5): e20-e32.
26 Kim SC, Kwon JG, Jeong WS, et al. Three-dimensional photogrammetric analysis of facial soft-to-hard tissue ratios after bimaxillary surgery in facial asymmetry patients with and without sturge-weber syndrome[J]. Ann Plast Surg, 2018, 81(2): 178-185.
27 Tseng YC, Chen HJ, Cheng JH, et al. Appearance on face reading (cheek line) after orthognathic surgery[J]. Br J Oral Maxillofac Surg, 2018, 56(5): 394-400.
28 Louis PJ, Austin RB, Waite PD, et al. Soft tissue changes of the upper lip associated with maxillary advancement in obstructive sleep apnea patients[J]. J Oral Maxillofac Surg, 2001, 59(2): 151-156.
29 Collins PC, Epker BN. The alar base cinch: a technique for prevention of alar base flaring secondary to maxillary surgery[J]. Oral Surg Oral Med Oral Pathol, 1982, 53(6): 549-553.
30 Tian JH, Wei DH, Zhao YJ, et al. Labial soft tissue contour dynamics following immediate implants and immediate provisionalization of single maxillary incisors: a 1-year prospective study[J]. Clin Implant Dent Relat Res, 2019, 21(3): 492-502.
[1] Liu Yuntong,Liu Chang,Gao Lichao,Luo Yuxue,Cao Yubin,Hua Chengge.. Research progress on the postoperative inferior alveolar neurosensory disturbance [J]. Int J Stomatol, 2023, 50(4): 479-484.
[2] Fan Yongjie,Dong Tingting.. Comparative study of facial soft tissue angle between Mongolian and Han adults in Inner Mongolia [J]. Int J Stomatol, 2022, 49(6): 648-656.
[3] Luo En. Exploration and clinical application of artificial intelligence in orthognathic surgery [J]. Int J Stomatol, 2022, 49(2): 125-131.
[4] Wang Yue,Wen Bing,Deng Mengting,Li Jianping. Research advances of low-level laser therapy on peri-implant tissue healing [J]. Int J Stomatol, 2021, 48(6): 725-730.
[5] Wang Lidong,Ma Wen,Fu Shuai,Zhang Changbin,Cui Qingying,Liang Yan,Li Ming. Research and accuracy of different methods of digital occlusal splint fabrication for orthognathic surgery [J]. Int J Stomatol, 2021, 48(2): 156-164.
[6] Wang Tao. Surgery first approach: one of the hotspots in orthognathic surgery and common problems [J]. Int J Stomatol, 2020, 47(5): 497-505.
[7] Fangfang Fang,Yaqin Chang,Yingchun Dong,Shasha Qin,Bin Chen. Xenogeneic collagen matrix versus autogenous connective tissue graft in periodontal soft tissue augmentation: a systematic review and Meta-analysis [J]. Inter J Stomatol, 2019, 46(2): 135-141.
[8] Lingling Liu,Shutai Liu. Measurement methods and relevant factors of the soft tissue thickness in the palatal masticatory mucosa of maxillary [J]. Inter J Stomatol, 2019, 46(2): 234-237.
[9] Xu Zhang,Yanxi Li,Hanshi Li,Jieya Wei,Xinyu Yan,Wei Zheng,Yu Li. Research progress on the prediction of the changes in soft tissue profile in orthodontic treatment [J]. Inter J Stomatol, 2019, 46(1): 105-111.
[10] Mengmeng Mi,Haibin Xia,Min. Wang. Research progress on enamel matrix derivative in dental implantation [J]. Inter J Stomatol, 2018, 45(5): 522-526.
[11] Fan Yongjie, A Ronggaowa. Stereophotogrammetry-based facial soft tissue measurement of Mongolian adults with normal occlusion [J]. Inter J Stomatol, 2018, 45(3): 291-294.
[12] Wan Shuangquan, Deng Feilong. Clinical applications of subepithelial connective tissue grafting in soft tissue deficiencies of dental implantation [J]. Inter J Stomatol, 2018, 45(1): 68-73.
[13] Chen Jing, Huang Xiaofeng.. Development of laser applications in orthodontics [J]. Inter J Stomatol, 2017, 44(6): 712-716.
[14] Fan Shengzi, Xie Zhigang.. Research progress on the effect of gingival biotype to implant aesthetic problems [J]. Inter J Stomatol, 2017, 44(5): 580-582.
[15] Dai Zhi, Hou Min, Zhang Chunxiang. Progression of mandibular retrognathism caused by progressive condylar resorption in orthognathic surgery [J]. Inter J Stomatol, 2017, 44(3): 359-362.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[2] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[3] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[4] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[5] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[6] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[7] . [J]. Foreign Med Sci: Stomatol, 2005, 32(06): 458 -460 .
[8] . [J]. Foreign Med Sci: Stomatol, 2005, 32(06): 452 -454 .
[9] . [J]. Inter J Stomatol, 2008, 35(S1): .
[10] . [J]. Inter J Stomatol, 2008, 35(S1): .