Three-dimensional Nasolabial Morphologic Alterations Following Le Fort I.
BACKGROUND
Le Fort I osteotomy imparts significant changes to the nasolabial region. Past studies have relied on 2-dimensional data and have not delineated differences among various Le Fort I subtypes. The purpose of this study is to 3-dimensionally analyze Le Fort I-induced nasal and lip changes comparing advancement alone versus widening alone [surgically assisted maxillary expansion (SAME)] versus advancement and widening. We hypothesize that the combination of maxillary advancement with widening will result in the most profound changes.


METHODS
A retrospective cohort study was performed. Included Le Fort I patients were grouped as: (1) nonsegmental straight advancement, (2) widening without advancement, and (3) segmental advancement and widening. Pre- and postoperative 3-dimensional photogrammetry (Canfield) were analyzed. Anthropometric landmarks were placed and measured by 2 independent observers. Statistics involved both paired and unpaired t tests (significance = P < 0.05).


RESULTS
One hundred eight photogrammetric data sets were analyzed, including 46 single-piece, 26 SAME, and 36 segmental. Significant postoperative nasal changes were observed within each intragroup analysis. The most dramatic changes were seen after segmental Le Fort I with advancement and widening, which included alar base width, alar width, nostril width, and soft triangle angle, all P < 0.05.


CONCLUSIONS
Le Fort I osteotomy results in significant alteration of the nasolabial morphology. This is the first study to 3-dimensionally analyze nasal changes that occur comparing maxillary advancement alone versus widening alone (SAME) versus advancement with widening. These objective data permit improved patient counseling and surgical planning.
Division of Oral and Maxillofacial Surgery, Division of Plastic and Craniomaxillofacial Surgery, and Division of Plastic and Reconstructive Surgery, and Yale University School of Medicine, Yale-New Haven Hospital, New Haven, Conn.
Christopher R
CR
DeSesa
Division of Oral and Maxillofacial Surgery, Division of Plastic and Craniomaxillofacial Surgery, and Division of Plastic and Reconstructive Surgery, and Yale University School of Medicine, Yale-New Haven Hospital, New Haven, Conn.
Philip
P
Metzler
Division of Oral and Maxillofacial Surgery, Division of Plastic and Craniomaxillofacial Surgery, and Division of Plastic and Reconstructive Surgery, and Yale University School of Medicine, Yale-New Haven Hospital, New Haven, Conn.
Rajendra
R
Sawh-Martinez
Division of Oral and Maxillofacial Surgery, Division of Plastic and Craniomaxillofacial Surgery, and Division of Plastic and Reconstructive Surgery, and Yale University School of Medicine, Yale-New Haven Hospital, New Haven, Conn.
Derek M
DM
Steinbacher