Yonsei Med J.  2018 Aug;59(6):793-797. 10.3349/ymj.2018.59.6.793.

Correction of Eyes and Lip Canting after Bimaxillary Orthognathic Surgery

• Yang CE
• Bae JY
• Lee J
• Lew DH

• KMID: 2415539
• DOI: http://doi.org/10.3349/ymj.2018.59.6.793

Abstract

Patients who have a lower facial asymmetry with compensatory head posture (developmental facial asymmetry) may have minor temporomandibular (T-M) joint problems and tend to mask their asymmetry by tilting the head for camouflage of their chin deviation. However, this compensatory head posture can give the impression of orbital dystopia and c spine deviation. When these patients undergo bimaxillary orthognathic surgery, orbital canting and head tilting improves gradually without the need for camouflage, and bleary eyes become clearer. We evaluated 13 patients who underwent LeFort I osteotomy combined with bilateral sagittal split osteotomy of the mandible for developmental facial asymmetry to quantitatively observe whole facial postural changes after surgery. Pre-operative and post-operative 1:1 full-face photographs of the patients were analyzed to compare the degrees of head tilting and orbital canting and the sizes of the eye opening. After bimaxillary orthognathic surgery, eye canting decreased from 2.6° to 1.5°, eye and lip lines came closer to parallel, and the degree of head tilting decreased from 3.4° to 1.3°. The eyes also appeared to open wider. Correction of lower facial skeletal asymmetry through bimaxillary orthognathic surgery improved head tilting and orbital canting gradually by eliminating the need of compensatory head posture. Facial expressions also changed as the size of the eyes increased due to the reduction of facial muscle tension caused by T-M joint dysfunction.

Keyword

Facial asymmetry; maxillofacial orthognathic surgery; treatment outcome

MeSH Terms

Chin
Facial Asymmetry
Facial Expression
Facial Muscles
Head
Humans
Joints
Lip*
Mandible
Masks
Orbit
Orthognathic Surgery*
Osteotomy
Posture
Spine
Treatment Outcome

Figure

• 

  Fig. 1 Schematic illustrations. (A) Natural head position. In the natural head position with a horizontal visual axis, a difference in height of the oral commissures is apparent. (B) Compensatory head posture. Tilting the head camouflages the lower face asymmetry, but results in canting of the orbital plane.

• 

  Fig. 2 In the compensatory head position, orbital canting was evaluated as the angle between true horizontal (left, dotted blue line) and the line connecting the centers of the pupils (left, linear blue line). The opening of the eye was calculated using the ImageJ program (National Institute of Health) by tracing the margin along the upper and lower eyelid (right, green area). Head tilting was evaluated as the angle between true vertical (left, dotted yellow line) and the line perpendicular to the interpupillary line (left, linear yellow line).

• 

  Fig. 3 The degree of orbital canting decreased by 42.8% (A). Eye opening area became wider after surgery but was not statistically significant (B). The degree of head tilting decreased by 60.6% (C). *p<0.05.

• 

  Fig. 4 Schematic illustrations reflect changes in appearance gradually over the 12-month postoperative period.

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