Soft tissue changes associated with ASO/BSSRO and Le Fort I/BSSRO in skeletal Class III malocclusion with upper lip protrusion

Ju-Man Kang; Yoon-Ji Kim; Je-Uk Park; Yoon-Ah Kook

doi:10.4041/kjod.2010.40.6.383

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Kang, Kim, Park, and Kook: Soft tissue changes associated with ASO/BSSRO and Le Fort I/BSSRO in skeletal Class III malocclusion with upper lip protrusion

Original Article

Korean Journal of Orthodontics

Korean Journal of Orthodontics 2010; 40(6): 383-397.

Published online: 31 December 2010

DOI: https://doi.org/10.4041/kjod.2010.40.6.383

Soft tissue changes associated with ASO/BSSRO and Le Fort I/BSSRO in skeletal Class III malocclusion with upper lip protrusion

Ju-Man Kang, DDS, MSD^a, Yoon-Ji Kim, DDS, MSD, PhD^b, Je-Uk Park, DDS, MSD, PhD^c, Yoon-Ah Kook, DDS, MSD, PhD^d

^aGraduate Student, Department of Orthodontics, Graduate School of Clinical Dental Science, The Catholic University of Korea, Korea.

^bAssistant Professor, Department of Orthodontics, Graduate School of Clinical Dental Science, The Catholic University of Korea, Korea.

^cProfessor, Department of Maxillofacial Surgery, Graduate School of Clinical Dental Science, The Catholic University of Korea, Korea.

^dProfessor, Department of Orthodontics, Graduate School of Clinical Dental Science, The Catholic University of Korea, Korea.

Corresponding author: Yoon-Ah Kook. Department of Orthodontics, Seoul St. Mary's Hospital, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-040, Korea. +82 2 2258 1777; kook2002@catholic.ac.kr.

Received 29 September 2009 Revised 25 May 2010 Accepted 1 June 2010

Abstract

Objective

The objective of this study was to compare maxillary soft tissue changes and their relative ratios to hard tissue changes after anterior segmental osteotomy (ASO)/bilateral sagittal split ramus osteotomy (BSSRO) and Le Fort I/BSSRO in skeletal Class III malocclusion with upper lip protrusion.

Methods

The study sample comprised the ASO/BSSRO group (n = 14) and the Le Fort I/BSSRO group (n = 15). The Le Fort I/BSSRO group included cases of maxillary posterior impaction only. Lateral cephalograms were taken 2 months before and 6 months after surgery. Linear and angular measurements were performed.

Results

The anterior maxilla moved backward in both groups after surgery, however the amount of change was significantly larger in the ASO/BSSRO group (p < 0.01). The ratios of hard to soft tissue change were 79% (SLS to A point), 80% (LS to A point) in the ASO/BSSRO group, and 15% (SLS to A point), 68% (LS to A point) in the Le fort I/BSSRO group. In addition, there was a 3.23° increase of the occlusal plane in the Le Fort I/BSSRO group.

Conclusions

When two-jaw surgery is indicated in skeletal Class III patients with protrusive lips, ASO may be a treatment of choice for cases with more severe upper lip protrusion, while Le Fort I with posterior impaction may be considered if an increase of occlusal plane angle is required.

Keywords: Two-jaw surgery, Soft tissue change, Le Fort I osteotomy, Anterior segmental osteotomy

Figures and Tables

Fig. 1

Reference lines & cephalometric landmarks. 1, Sella (S): the center of the sella turcica; 2, Nasion (N): the most anterior point of the frontonasal suture; 3, Porion11 (Po): the most superior point of contour of external auditory meatus; 4, Orbitale (Or): the lowest point of the lower margin of the bony orbit; 5, Anterior nasal spine (ANS): the tip of the anterior nasal spine of the palatal bone in the hard palate; 6, Posterior nasal spine (PNS): the tip of the posterior nasal spine of the palatal bone in the hard palate; 7, Subspinale (A point): the most posterior point on the anterior contour of the upper alveolar process; 8, Supradentale (SD): the lowermost point on the alveolar portion of the premaxilla; 9, Upper incisor edge (UIE): the incisal edge of the upper central incisor; 10, Supramentale (B point): the most posterior point on the anterior contour of the lower alveolar process; 11, Pronasale (Pn): the most anterior projection of the nose; 12, Columella12 (Cm): the most anterior soft tissue point on the columella of the nose; 13, Subnasale11 (Sn): the point at which the columella merges with the upper cutaneous lip; 14, Superior labial sulcus (SLS): the point of greatest concavity in the midline of the upper lip; 15, Labrale superius (LS): the point indicating the mucocutaneous border of the upper lip; 16, Stomion superius (Stms): the lowermost point on the vermillion of the upper lip.

Fig. 2

Horizontal and vertical linear measurements. HRL, Horizontal reference line; VRL, vertical reference line; A, 1, ANS to VRL; 2, PNS to VRL; 3, A point to VRL; 4, supradentale to VRL; 5, upper incisor edge to VRL; 6, pronasale to VRL; 7, columella to VRL; 8, subnasale to VRL; 9, superior labial sulcus to VRL; 10, labrale superius to VRL; B, 1, ANS to HRL; 2, PNS to HRL; 3, A point to HRL; 4, supradentale to HRL; 5, upper incisor edge to HRL; 6, pronasale to HRL; 7, columella to HRL; 8, subnasale to HRL; 9, superior labial sulcus to HRL; 10, labrale superius to HRL.

Fig. 3

Angular measurements. 1, SNA; 2, SNB; 3, ANB; 4, FH-occlusal plane; 5, SN-palatal plane; 6, nasolabial angle (columella-subnasale-labrale superius); 7, U1-SN.

Fig. 4

Upper lip length and thickness. HRL, Horizontal reference line; VRL, vertical reference line; A, 1, Subnasale to stomion superius; B, 1, subnasale to subnasale horizontal; 2, superior labial sulcus to superior labial sulcus horizontal; 3, labrale superius to labrale superius horizontal.

Table 1

Number, gender, and mean age of sample in anterior segmental osteotomy/bilateral sagittal split ramus osteotomy group (ASO/BSSRO) and Le Fort I osteotomy/bilateral sagittal split ramus osteotomy group (Le Fort I/BSSRO)

Table 2

Presurgical measurements in anterior segmental osteotomy/bilateral sagittal split ramus osteotomy group (ASO/BSSRO) and Le Fort I osteotomy/bilateral sagittal split ramus osteotomy group (Le Fort I/BSSRO)

NS, Not significant; VRL, vertical reference line; HRL, horizontal reference line; SD, supradentale; UIE, upper incisor edge; Pn, pronasale; Cm, columella; Sn, subnasale; SLS, superior labial sulcus; LS, labrale superius; Stms; stomion superius; SnH, subnasale horizontal; SLSH, superior labial sulcus horizontal; LSH, labrale superius horizontal.

Table 3

Skeletal and soft tissue changes in anterior segmental osteotomy/bilateral sagittal split ramus osteotomy group (n = 14)

Table 4

Skeletal and soft tissue changes in Le Fort I osteotomy/bilateral sagittal split ramus osteotomy group (n = 15)

Table 5

Comparative postsurgical changes in anterior segmental osteotomy/bilateral sagittal split ramus osteotomy group (ASO/BSSRO) and LeFort I osteotomy/bilateral sagittal split ramus osteotomy group (Le Fort I/BSSRO)

Table 6

Ratio of horizontal change of soft tissue to hard tissue in anterior segmental osteotomy/bilateral sagittal split ramus osteotomy group (ASO/BSSRO)

Pn, Pronasale; VRL, vertical reference line; Sn, subnasale; SLS, superior labial sulcus; LS, labrale superius; A, A point; SD, supradentale; UIE, upper incisor edge. ^*p < 0.01; ^†p < 0.001.

Table 7

Ratio of horizontal change of soft tissue to hard tissue in LeFort I osteotomy/bilateral sagittal split ramus osteotomy group (Le Fort I/BSSRO)

Pn, Pronasale; VRL, vertical reference line; Sn, subnasale; SLS, superior labial sulcus; LS, labrale superius; A, A point; SD, supradentale; UIE, upper incisor edge. ^*p < 0.01; ^†p < 0.001.

Table 8

Ratio of change of measurements to amount of posterior impaction in LeFort I osteotomy/bilateral sagittal split ramus osteotomy group (Le Fort I/BSSRO)

UIE, Upper incisor edge; VRL, vertical reference line; LS, labrale superius; HRL, horizontal reference line. ^*p < 0.05; ^†p < 0.001. Amount of posterior impaction: ΔPNS to HRL - ΔANS to HRL.

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