3D Nasolabial Changes following Le Fort I
Philipp Metzler, MD, Eric Geiger, BS, Christopher Chang, MD, Derek M. Steinbacher, MD.
Yale, New Haven, CT, USA.
Introduction: Le Fort I osteotomy imparts requisite soft-tissue changes. Most notable is the alteration in nasal form and position due to the piriform and anterior nasal spine relationship to the overlying nasal base. Nasolabial changes have previously been documented using soft-tissue shadowing 2D radiographs. However, comprehensive morphologic assessment has not been performed using high-resolution 3D imaging. Additionally, comparing different sub-types of the Le Fort I maxillary movements has not been compared. The purpose of this study is to three-dimensionally document nasolabial changes following single-piece Le Fort I, multi-piece Le Fort I, and transverse maxillary widening.
Methods: This study was approved by our institutional review committee. Subjects undergoing elective osteotomy at the Le Fort I level were included. Pre- and postoperative 3D photographs (3D VECTRA) were recorded. Demographic information was tabulated including patients’ age, gender and diagnosis. Peri-operative details were documented. Nasolabial anthropometric measurements were performed using the corresponding 3-D post-processing software. A follow-up period of at least twelve months was required for final evaluation.
Results: Ninety-two pre- and post-operative 3D photo data sets of patients, who underwent Le Fort I advancement alone or with multi-segmental widening or surgically-assisted maxillary expansion (SAME) were included. Male/ female ratio was 1.2 with a mean age of 16.9 years. The fronto-nasal angle was found to significantly (p<0.05) decrease between 1-5 degrees post-operatively in all three groups. Postoperative nasal tip advancement was significantly (p<0.05) advanced in all groups. Significant differences were seen in postoperative nasal, columellar, subnasal, and upper lip projections between the advancement and the SAME groups. Nasal tip projection was a significantly (p<0.05) decreased post-operatively in the advancement groups but not with SAME. Subnasal and lateral nasal regions were significantly wider in the multi-segment population compared to Le Fort I alone. The nasal width increase was significantly less in SAME compared to both advancement
groups. The upper and lower transverse philtral distances were also greater in the multi-segment group in comparison with the one-piece group. The SAME group showed no significant differences in the in transverse philtral dimensions.
Changes in nostril dimensions (including nostril height, nostril width, and sill width) and in shape (including soft triangle and lateral alar angles) were significant in all three groups. The columellar width showed no significant (p>0.05) changes in all groups.
Conclusion: This is the first study to objectively analyze 3D nasolabial changes following Le Fort I osteotomy, comparing frequent subtypes of the procedure. Maxillary advancement impacts nasolabial morphology to a greater extent than transverse expansion alone. Concurrent maxillary advancement with widening leads to the most dramatic soft tissue changes. This data suggests that soft-tissue changes within the nasolabial region after Le Fort I advancement occur in a manner more complex than previously described. However, each Le Fort I subtype generates a predictable soft-tissue response.
3D soft tissue changes pre- (grey), post- (mesh) following multi-segment Le Fort I advancement
Back to Program