Korean J Orthod.  2020 Jul;50(4):249-257. 10.4041/kjod.2020.50.4.249.

Three-dimensional assessment of nasal changes after maxillary advancement with impaction using stereophotogrammetry

• Coban G
• Yavuz I
• Karadas B
• Demirbas AE

• KMID: 2504142
• DOI: http://doi.org/10.4041/kjod.2020.50.4.249

Abstract

Objective
To evaluate the changes in the nose in three dimensions after Le Fort I osteotomy in patients with skeletal Class III malocclusion.
Methods
The subjects were 40 adult patients (20 females and 20 males; mean age, 20.3 ± 3.0 years; range, 17.0 to 31.1 years) who underwent one-piece Le Fort I osteotomy with maxillary advancement and impaction treatment for maxillary hypoplasia. The mean maxillary advancement was 4.56 ± 1.34 mm, and the mean maxillary impaction was 2.03 ± 1.04 mm. Stereophotogrammetry was used to acquire three-dimensional images before and at least 6 months after surgery.
Results
Alare (Al) and alare curvature (Ac) points had moved vertically and anterolaterally postoperatively. A significant increase was observed in the nasal ala width and alar base width, and no changes were noted in the columellar length, nasolabial angle, and nasal area. There was a significant relationship between maxillary impaction and nasal ala width and horizontal and sagittal positions of the bilateral Al and Ac. The only relationship found was between maxillary advancement and postoperative sagittal location of the subnasale and pronasale.
Conclusions
Nasal soft tissues were highly affected by the vertical movement of the maxilla; however, the soft tissue responses were individual-dependent.

Keyword

3D stereophotogrammetry; Class III orthognathic surgery; Soft tissue nasal changes

Figure

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  Figure 1 Evaluation of surgical quantities of hard tissues. N, Nasion; S, sella; A, A point; ANS, anterior nasal spina; PNS, posterior nasal spina; HRP, horizontal reference plane; VRP, vertical reference plane.

• 

  Figure 2 A, Reference markers used for superimposition: forehead area (the wide surface over the eyebrows), nasion area (the corresponding soft tissue point from the nasal root to the nasal hump), and exocanthion (the 3/4 lateral regions of the exocanthion). B, Soft tissue landmarks. na, Soft tissue nasion; en, endocanthion; ex, exocanthion; prn, pronasale; cc, columella constructed point; al, alare; ac, alare curvature; sn, subnasale; ls, labiale superior; r, right; l, left.

• 

  Figure 3 A, Axial reference plane passing through both endocanthions when the patients had their natural head positions. Sagittal reference plane passing through na, perpendicular to the axial and coronal reference planes; coronal reference plane passing through both exocanthions, perpendicular to the axial and sagittal planes. B, External nasal surface area measurement was computed following soft tissue nasal borders. na, Soft tissue nasion; ac, alare curvature; sn, subnasale; r, right; l, left.

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