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Nasal profile changes after maxillary impaction and advancement surgery
M Y Mommaerts1, F Lippens, J V Abeloos
1Department of Surgery, General Hospital St John, Bruges, Belgium. maxfac@azbrugge.be
Summary
Subspinal osteotomy does not reduce nasal tip changes or improve the columello-labial angle compared to conventional Le Fort I osteotomy in maxillary advancement surgery. Nasal tip projection increase is linked to piriform aperture movement, not the nasal spine.
Area of Science:
- Oral and Maxillofacial Surgery
- Orthognathic Surgery
- Craniofacial Surgery
Background:
- Maxillary advancement and impaction surgery are used to correct skeletal discrepancies.
- Nasal tip and columello-labial region changes are common sequelae.
- Subspinal osteotomy is proposed as an alternative to conventional Le Fort I osteotomy to minimize these changes.
Purpose of the Study:
- To compare nasal tip and columello-labial region profile changes between subspinal osteotomy and conventional Le Fort I osteotomy.
- To test if subspinal osteotomy results in less nasal tip alteration and a more acute columello-labial angle.
Main Methods:
- Analysis of lateral cephalograms from 46 patients (23 per group).
- Matched groups with and without subspinal osteotomy undergoing maxillary advancement/impaction.
- Electronic analysis of cephalometric parameters.
Main Results:
- No significant difference in nasal tip elevation or projection changes between the two osteotomy groups.
- Columello-labial angle remained largely unchanged post-surgery in both groups.
- Palatal plane rotation significantly influenced nasal tip projection, particularly in the conventional Le Fort I group.
Conclusions:
- The advancing piriform aperture, not the nasal spine, is the primary driver of increased nasal tip projection.
- Subspinal osteotomy offers no advantage over conventional Le Fort I osteotomy in minimizing nasal tip changes or controlling the columello-labial angle.