Predicting upper lip response to 4-piece maxillary LeFort I osteotomy

The purpose of this retrospective study was to understand and predict the multidimensional changes in upper lip morphologic features after segmental (4-piece) maxillary Le Fort I advancement/impaction with VY closure and alar base cinch sutures. The study evaluated longitudinal lateral cephalograms of 57 patients (42 women, 15 men) 27.5 +/- 11.2 years of age before surgery. Lateral cephalograms with teeth in occlusion and lips in repose were taken 2 weeks before surgery and at least 6 months after the operation. Mean postsurgical duration was 15.5 months. The upper lip predictably moved anteriorly in a graduated fashion, from 50% (subnasale) to 90% (labrale superius) the amount of the underlying osseous anterior movement, and showed a slight lengthening (0.73 +/- 1.9 mm) from subnasale to upper lip stomion. The upper lip surface contour was also straightened as a result of the surgical movement. Multiple regression models showed that the anterior changes in the landmarks prosthion and facial surface of the upper incisor were the most important variables in predicting upper lip response. The prediction equations for horizontal movements explained 86% to 94% of the variation, with errors of the estimates that range between 1.27 mm and 1.65 mm. The models, when applied to an independent validation sample of 14 subjects, explained between 86% and 94% of the total variation. The conclusion is that upper lip response after 4-piece Le Fort I advancement/impaction (VY closure and alar base cinch suture) can be accurately predicted.