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Does Le Fort I Osteotomy Influence Nasal Septum Deviation?
Canay Yılmaz Asan1, Ebru Baydan2, Mehmet Amuk3
1Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Kayseri, Turkey.
Background:
Le Fort I osteotomy is a technique for surgically correcting the maxillary position. Le Fort I osteotomy may affect the nasolabial structures since a very close relationship exists between the maxilla and the nose.
Purpose:
This study aimed to investigate the effect of different maxillary movements on the nasal septum after Le Fort I osteotomies with cone beam computed tomography (CBCT) images. We hypothesized that nasal septal angle changes after maxillary impaction and advancement movements.
Study Design, Setting, And Sample:
This retrospective cohort study involved patients who underwent Le Fort I osteotomy to correct the maxillary position at Erciyes University, Oral and Maxillofacial Surgery Hospital. This study included patients who had CBCT images before (T0) and ≥12 months after (T1) surgery. Patients with a history of septoplasty or rhinoplasty before orthognathic surgery, congenital deformities, or posttraumatic deformities were excluded.
Predictor Variables:
Its predictor variable was the direction and magnitude of the maxilla's vertical and horizontal movements.
Main Outcome Variable:
Change in septal deviation (in degrees) was the main outcome of the study.
Covariates:
Age, sex, operation (Le Fort I alone or double jaw surgery), cartilage reduction, and anterior nasal spine reduction during surgery were covariates.
Data Analysis:
Angle values were compared with independent samples t test or the Mann-Whitney U test in two-category variables. The Kruskal Wallis test was used to compare the angle values according to the movement. A P value of < .05 was considered statistically significant.
Results:
This study evaluated 154 CBCT images of 77 patients (44 [57.1%] females and 33 [42.9%] males), of which 68 (88.3%) had double jaw surgery and nine (11.7%) had single Le Fort I surgery. The average nasal septum angle was significantly smaller preoperatively (166.2° [157.1° to 172.15°]) than postoperatively (168.7° [131.5° to 180.0°]) across subjects (P = .031). The septal angle decreased in 28 patients, and the rate of postoperative angular change was higher in patients with both advancement and impaction during the surgery (P = .014).
Conclusion And Relevance:
Septum deviation can occur in 37% of cases after Le Fort I surgery. Therefore, Le Fort osteotomies are associated with changes in nasal appearance.
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