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)

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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"

"

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