Soft tissue changes of upper lip and nose following posterosuperior rotation of the maxilla by Le Fort I osteotomy

Young-Wook Kwon; Sung-Woon Pyo; Won Lee; Je Uk Park

doi:10.5125/jkaoms.2011.37.6.457

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Kwon, Pyo, Lee, and Park: Soft tissue changes of upper lip and nose following posterosuperior rotation of the maxilla by Le Fort I osteotomy

Original Article

J Korean Assoc Oral Maxillofac Surg 2011;37(6):457-463.

Published online: 10 January 2011

DOI: https://doi.org/10.5125/jkaoms.2011.37.6.457

Soft tissue changes of upper lip and nose following posterosuperior rotation of the maxilla by Le Fort I osteotomy

Young-Wook Kwon¹, Sung-Woon Pyo², Won Lee³, Je Uk Park¹

¹Department of Oral and Maxillofacial Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul

²Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon

³Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea

Je Uk Park Department of Oral and Maxillofacial Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea 505 Banpo-dong, Seocho-gu, Seoul, 137-501, Korea TEL: +82-2-2258-6291 FAX: +82-2-237-5374 E-mail: jupark@catholic.ac.kr

Received 13 June 2011 Revised 30 August 2011 Accepted 12 October 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction

This study evaluate the soft tissue changes to the upper lip and nose after Le Fort I maxillary posterosuperior rotational movement.

Materials and Methods

Twenty Skeletal class III patients, who had undergone bimaxillary surgery with a maxillary Le Fort I osteotomy and bilateral sagittal split ramus osteotomy, were included in the study. The surgical plan for maxilla was posterosuperior rotational movement, with the rotation center in the anterior nasal spine (ANS) of maxilla. Soft and hard tissue changes were measured by evaluating the lateral cephalograms obtained prior to surgery and at least 6 months after surgery. For cephalometric analysis, four hard tissue landmarks ANS, posterior nasal spine [PNS], A point, U1 tip), and five soft tissue landmarks (pronasale [Pn], subnasale [Sn], A' Point, upper lip [UL], stomion superius [StmS]) were marked. A paired t test, Pearson's correlation analysis and linear regression analysis were used to evaluate the soft and hard tissue changes and assess the correlation. A P value <0.05 was considered significant.

Results

The U1 tip moved 2.52±1.54 mm posteriorly in the horizontal plane (P<0.05). Among the soft tissue landmarks, Pn moved 0.97±1.1 mm downward (P<0.05), UL moved 1.98±1.58 mm posteriorly (P<0.05) and 1.18±1.85 mm inferiorly (P<0.05), and StmS moved 1.68±1.48 mm posteriorly (P<0.05) and 1.06±1.29 mm inferiorly (P<0.05). The ratios of horizontal soft tissue movement to the hard tissue were 1:0.47 for the A point and A' point, and 1:0.74 for the U1 tip and UL. Vertically, the movement ratio between the A point and A' point was 1:0.38, between U1 tip and UL was 1:0.83, and between U1 tip and StmS was 1:0.79.

Conclusion

Posterosuperior rotational movement of the maxilla in Le Fort I osteotomy results in posterior and inferior movement of UL. In addition, nasolabial angle was increased. Nasal tip and base of the nose showed a tendency to move downward and showed significant horizontal movement. The soft tissue changes in the upper lip and nasal area are believed to be induced by posterior movement at the UL area.

Keywords: Orthognathic surgery, Le Fort osteotomy, Cephalometry, Angle class III malocclusion

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Fig. 1.

Cephalometric landmarks and reference planes. (ANS: anterior nasal spine, PNS, posterior nasal spine; A, A point; U1 tip, upper incisor tip; Pn, pronasale; Sn, subnasale; A', soft tissue A point; UL, upper lip; StmS, Stomion superius) Young-Wook Kwon et al: Soft tissue changes of upper lip and nose following posterosuperior rotation of the maxilla by Le Fort I osteotomy. J Korean Assoc Oral Maxillofac Surg 2011

Table 1.

Horizontal, vertical (mm) and angular (^o) changes of hard and soft tissue landmarks (T0-T1)

	Horizontal		Vertical			Angle
Landmark					Angular measurement
Hard tissue					Palatal plane angle	(2.24)	−5.90^*
ANS	0.68^*	(1.18)	−0.07^*	(1.27)	U1 angle	(3.97)	3.73^*
PNS	−0.12	(0.10)	4.76^*	(1.38)	Nasolabial angle	(4.93)	−5.93^*
A point	1.5^*	(1.43)	0.53	(1.27)
U1 tip	2.52^*	(1.54)	−0.37	(1.34)
Soft tissue
Pronasale	0.91	(1.08)	−0.97^*	(1.10)
Subnasale	0.44	(1.15)	−1.05^*	(0.90)
Soft tissue A point	0.31	(1.12)	−1.00^*	(0.84)
Upper lip	1.98^*	(1.58)	−1.18^*	(1.85)
Stomion superius	1.68^*	(1.48)	−1.06^*	(1.29)

(ANS, anterior nasal spine; PNS, posterior nasal spine)

^* P<0.05) Values are presented as mean (standard deviation).

Positive value inhorizontal movement indicates posterior movement and negative value indicates anterior movement. Positive value in vertical movement indicates superior movement and negative value indicates inferior movement. Young-Wook Kwon et al: Soft tissue changes of upper lip and nose following posterosuperior rotation of the maxilla by Le Fort I osteotomy. J Korean Assoc Oral Maxillofac Surg 2011

Table 2.

Correlations between corresponding soft to hard tissue movements and soft to hard tissue movement ratios in both horizontal and vertical planes

Hard tissue variable	Soft tissue variable	r	R²	β(S:H)
Horizontal ANS	Pn horizontal	0.76^*	0.58	0.69
A point	A' horizontal	0.59^*	0.35	0.47
U1 tip	UL horizontal StmS vertical	0.73^*	0.53	0.74
Vertical ANS	Pn vertical	0.17	0.02	0.15
A point	A' vertical	0.57^*	0.33	0.38
U1 tip	UL vertical	0.61^*	0.37	0.83
	StmS vertical	0.82^*	0.67	0.79

(r: Pearson correlation coefficient, R

² coefficient of determination, ANS: anterior nasal spine, PNS: posterior nasal spine, Pn: pronasale, UL: upper lip, StmS: stomion superius)

^* P<0.05)

Young-Wook Kwon et al: Soft tissue changes of upper lip and nose following posterosuperior rotation of the maxilla by Le Fort I osteotomy. J Korean Assoc Oral Maxillofac Surg 2011

Table 3.

Correlations between hard tissue angular changes to soft tissue movement and their ratios

Angular measurement	Soft tissue variable	r	R²	β(S:H)
U1 to HRL	UL horizontal	0.22	0.05	0.09
	StmS vertical	−0.22	0.05	−0.07
	Nasolabial angle	−0.44^*	0.19	−0.54
Palatal plane angle	UL horizontal	0.01	0.0001	0.007 1
	StmS vertical	0.23	0.05	0.13
	Nasolabial angle	0.14	0.02	0.31

(r: Pearson correlation coefficient, R

² coefficient of determination, HRL: horizontal reference line, UL: upper lip, StmS: stomion superius)

^* P<0.05)

Young-Wook Kwon et al: Soft tissue changes of upper lip and nose following posterosuperior rotation of the maxilla by Le Fort I osteotomy. J Korean Assoc Oral Maxillofac Surg 2011

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