J Korean Assoc Oral Maxillofac Surg.  2020 Dec;46(6):385-392. 10.5125/jkaoms.2020.46.6.385.

Study of soft tissue changes in the upper lip and nose after backward movement of the maxilla in orthognathic surgery

• Seon S
• Lee HW
• Jeong BJ
• Lee BS
• Kwon YD
• Ohe JY

• KMID: 2510008
• DOI: http://doi.org/10.5125/jkaoms.2020.46.6.385

Abstract

Objectives
This study evaluates soft tissue changes of the upper lip and nose after maxillary setback with orthognathic surgery such as Le Fort I or anterior segmental osteotomy.
Materials and Methods
All 50 patients with bimaxillary protrusion and skeletal Class II malocclusion underwent Le Fort I or anterior segmental osteotomy with backward movement. Soft and hard tissue changes were analyzed using cephalograms collected preoperatively and 6 months postoperatively.
Results
Cluster analysis on the ratios shows that 2 lines intersected at 4 mm point. Based on this point, we divided the subjects into 2 groups: Group A (less than 4 mm, 27 subjects) and Group B (more than 4 mm, 23 subjects). Also, each group was divided according to changes of upper incisor angle (≥4°=A1, B1 or <4°=A2, B2). The correlation between A and B groups for Aʼ/ANS and Ls/Is (P<0.001) was significant; Aʼ/A (P=0.002), PRN/A (P=0.043), PRN/ANS (P=0.032), and St/Is (P=0.010). Variation of nasolabial angle between the two groups was not significant. There was no significant correlation of vertical movement and angle variation.
Conclusion
The ratio of soft tissue to hard tissue movement depends on the amount of posterior movement in the maxilla, showing approximately two times higher rates in most of the midface when posterior movement was greater than 4 mm. The soft tissue changes caused by posterior movement of the maxilla were little affected by angular changes of upper incisors. Interestingly, nasolabial angle showed a different tendency between A and B groups and was more affected by incisal angular changes when horizontal posterior movement was less than 4 mm.

Keyword

Orthognathic surgery; Soft tissue change; Maxillary setback; Cephalogram

Figure

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  Fig. 1 Cephalometric hard tissue landmarks and reference planes. (HRL: horizontal reference line, S: sella, N: nasion, ANS: anterior nasal spine, A: A point, Ia: incisor anterius, Is: incisor superius, Upper incisor angle: upper incisor to HRL, VRL: vertical reference line)

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  Fig. 2 Cephalometric soft tissue landmarks and reference planes. (HRL: horizontal reference line, S: sella, PRN: pronasale, Sn: subnasale, A’: soft tissue A point, Ls: labrale superius, St: stomion superius, VRL: vertical reference line)

• 

  Fig. 3 Relaptionship between the movement of hard tissue and soft tissue. Ratio of soft tissue on the hard tissue. Two different gradient lines crossing near the 4 mm (x-axis) point.

Reference

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