Changes in facial movement after maxillary osteotomies

Determine changes in facial movement while smiling after maxillary Le Fort I osteotomies.

Twenty patients (ages 15 to 38) treatment-planned for maxillary Le Fort I osteotomies were divided into two groups. Group A consisted of 10 patients who underwent superior and/or posterior positioning of the maxilla. Group B consisted of 10 patients who underwent anterior and/ or inferior repositioning of the maxilla. All patients underwent preoperative and postoperative (3 to 8 months) videographic analysis of a maximal closed mouth smile by the Johnson Maximal Static Response Assay, evaluating four landmarks around the mouth and nose (alar base--A, cheilion--C, labrale superioris--Ls, and intermediate between cheilion and labrale superioris--Im).

Group A was noted to have a statistically significant decrease in movement of the face at points C and Im. No significant change was seen for points Ls and A. Group B was noted to have a statistically significant increase in movement of the face at point A, C, and Im. Point Ls was also found to increase, however not significantly.

Surgical repositioning of the maxilla anteriorly and/or inferiorly lengthens the facial musculature resulting in an increase in facial movement while smiling. Likewise surgically repositioning the maxilla superiorly and/or posteriorly reduces the length of the facial musculature, resulting in a decrease in facial movement while smiling.