Factors that worsen nasal ventilation after Le Fort I osteotomy with superior repositioning

This study aimed to assess nasal ventilation after Le Fort I osteotomy with superior maxillary repositioning, using nasal resistance and the nasal obstruction symptom evaluation (NOSE) score, and to identify factors contributing to its deterioration. Of the 86 patients who underwent Le Fort I osteotomy, those in whom nasal resistance and NOSE scores could be measured were included. Patients were divided into a conventional group (Conv) with low superior repositioning (<3.5 mm at the maxillary first molar), a superior group (Supe) with high superior repositioning (≥3.5 mm), and an additional group (Add) with high superior repositioning plus horseshoe osteotomy or partial turbinectomy. Additionally, binomial logistic regression was performed to identify the factors that worsen nasal ventilation. The change in NOSE scores from preoperative to 1 year postoperative was significantly greater in the Supe group than in the Conv and Add groups (P = 0.004). The results of the binomial logistic regression showed that the major factors that worsened nasal ventilation were the high superior repositioning (P = 0.042) and the presence of nasal septal curvature (P = 0.002). Additional surgical procedures such as horseshoe osteotomy or partial turbinectomy were a factor inhibiting the deterioration of nasal ventilation (P = 0.043). In cases where high superior maxillary repositioning is planned, preoperative evaluation of the nasal septum for curvature would be helpful. In addition, it is important to consider additional surgical procedures such as horseshoe osteotomy or partial turbinectomy to avoid narrowing the lower nasal passage as needed.