title: Change in inferior sclera exposure following Le Fort I osteotomy in patients with midfacial retrognathia.
abstract: OBJECTIVE
  For facial esthetic reasons, no sclera should be exposed above or below the irises when the head of a patient who has a normal skeletal pattern is in a neutral position and the eyelids are in a relaxed position. This study evaluated the decrease in sclera exposure after maxillary advancement or impaction in patients with midfacial hypoplasia.
  
  
  METHODS
  Forty-seven consecutive patients (24 male, 23 female) who underwent Le Fort I osteotomy were included. The patients were divided into 2 groups according to type of maxillary movement: group I underwent maxillary advancement (n = 23) and group II underwent maxillary advancement and impaction surgery (n = 24). Standardized preoperative and 6-month postoperative photographs of the frontal view of patients were evaluated using Adobe Photoshop CS5. The proportion of inferior sclera exposure to eye height was determined, and the proportional difference between the preoperative and postoperative orbital views was statistically analyzed.
  
  
  RESULTS
  The proportion of inferior sclera exposure to eye height decreased by a ratio of 0.07 (P = .001) in the right and left eyes of the 47 patients, with an average maxillary advancement of 6.1 mm. The proportion of inferior sclera exposure to eye height of the right and left eyes decreased from 0.1 to 0.02 and from 0.09 to 0.02, respectively, in group I (P = .001). The proportion of inferior sclera exposure to eye height decreased in group II by a ratio of 0.06 in the right and left eyes (P = .001).
  
  
  CONCLUSIONS
  Inferior sclera exposure in patients with midfacial hypoplasia and retrognathia decreases significantly in accordance with the change in the lower eyelid position after maxillary advancement or impaction surgeries.
authors: Fellow, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey. Electronic address: sdksoydan@yahoo.com.
authors: Sidika Sinem
authors: SS
authors: Soydan
authors: Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey.
authors: Burak
authors: B
authors: Bayram
authors: Assistant Professor, Department of Orthodontics, Faculty of Dentistry, Baskent University, Ankara, Turkey.
authors: Cagla
authors: C
authors: Sar
authors: Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey.
authors: Sina
authors: S
authors: Uckan
mesh_terms: D059925:Anatomic Landmarks / Q000473:pathology; D002508:Cephalometry / Q000379:methods; D005123:Eye / Q000473:pathology; D005143:Eyelids / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008313:Malocclusion, Angle Class III / Q000601:surgery; D008437:Maxilla / Q000002:abnormalities* / Q000601:surgery; D009915:Orbit / Q000473:pathology; D056948:Orthognathic Surgical Procedures / Q000379:methods; D019340:Osteotomy, Le Fort / Q000379:methods*; D059229:Osteotomy, Sagittal Split Ramus / Q000379:methods; D010781:Photography / Q000379:methods; D063173:Retrognathia / Q000601:surgery*; D012590:Sclera / Q000473:pathology*; D055815:Young Adult