Le Fort I osteotomy and soft tissue response: A retrospective cohort study comparing three different techniques

Area of Science:

• Oral and Maxillofacial Surgery
• Orthognathic Surgery
• 3D Imaging in Dentistry

Background:

• Le Fort I osteotomy is a common surgical procedure for correcting midface discrepancies.
• Understanding the impact of different osteotomy techniques on nasolabial soft tissues is crucial for aesthetic outcomes.
• Cone beam computed tomography (CBCT) offers advanced 3D visualization for evaluating surgical changes.

Purpose of the Study:

• To compare the effects of three Le Fort I osteotomy techniques on nasolabial soft tissues.
• To evaluate changes in inter-alar width and alar base width using 3D CBCT analysis.
• To determine which technique best preserves the nasolabial region's aesthetics.

Main Methods:

• A retrospective study involving 90 patients divided into three groups: conventional Le Fort I, subspinal Le Fort I, and conventional Le Fort I with ANS recontouring.
• CBCT scans were taken before surgery (T0) and 6 months post-surgery (T1).
• Three-dimensional surface analysis was used to measure changes in nasolabial soft tissues.

Main Results:

• All techniques resulted in significant changes to the nasolabial area (P < 0.001).
• Subspinal Le Fort I osteotomy showed statistically significant smaller mean changes in inter-alar width (1.20 mm) and alar base width (0.85 mm) compared to conventional techniques.
• Conventional Le Fort I with ANS recontouring showed intermediate changes.

Conclusions:

• Subspinal Le Fort I osteotomy appears to be the preferred technique when minimizing alterations in the nasolabial region is a priority.
• CBCT is a valuable tool for assessing 3D soft tissue changes after orthognathic surgery.
• Further research may explore long-term stability and patient-reported outcomes.