Downloaded from http://journals.lww.com/jcraniofacialsurgery by BhDMf5ePHKbH4TTImqenVJua3JJgqHHloZDaxzhQKVd5QMkOH2LaB7D901XtPhY5 on 06/06/2020 Copyright © 2020 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. The Effects of Maxillary Movements on Nasal Aesthetics Following Orthognathic Surgery Galip Gencay U ¨ stu¨n, MD, MSc,  Ersoy Konas¸, MD,  Hakan El, DDS, PhD, y Bengisu Akarsu Gu¨ven, DDS, PhD, y Osman Dag˘, PhD, z Haldun Kamburog˘lu, MD, § and Mehmet Emin Mavili, MD  Abstract: Improvement of the harmony between facial subunits is the ultimate goal of orthognathic surgery and surgeons must accu- rately make soft tissue projections for planned bony movements. Yet, few studies have examined the effects’ of orthognathic surgery on aesthetic parameters of nasolabial area on a thorough basis. This retrospective study included 61 patients that underwent orthognathic surgery. Demographic data, evaluation period, and surgical details were analyzed. Superficial topographical analysis of intercanthal distance, alar width, nasal height, nasal length, nasal tip protrusion, upper lip height, nasal bone angle, supratip break angle, nasal dorsum angle, nasal tip angle, columellar-lobular angle, columellar-labial angle, upper lip angle, and tip-to-midline angle was recorded before and after surgery. Postoperative changes in these parameters and their correlation to maxillary movements were analyzed. Alar width, upper lip height, columellar-labial angle, supratip break angle, nasal dorsum angle, and upper lip angle increased postsurgery, whereas tip-to-midline angle decreased. Upper lip height and columellar-labial angle were significantly correlated with clockwise/counter-clockwise rotation and anterior re-positioning. Columellar-labial angle increased 28 for each 1 mm of anterior movement and decreased 48 for each 1 mm of counter-clockwise rotation. Novel parameters, such as columellar-lobular angle and tip- to-midline angle, were not associated with any maxillary movement postsurgery. Orthognathic surgery primarily affected the lower third of the nose and changed alar width, upper lip height, supratip break angle, nasal dorsum angle, columellar-labial angle, upper lip angle, and tip- to-midline angle in this region; however, only columellar-labial angle and upper lip height were found to be correlated solely with maxillary movements. Key Words: Lefort I osteotomy, maxilla, nasolabial, rhinoplasty, soft tissue analysis (J Craniofac Surg 2020;31: 796–800) T he aim of orthognathic surgery is mobilization of the jaws towards the proper position and fixation in 3-dimensional space. It has been shown to be beneficial in cases of chewing disorders, obstructive sleep apnea, and temporomandibular joint dysfunc- tion. 1–3 In addition to these functional benefits, improvement of the harmony between the facial subunits is another compelling indication for orthognathic surgery. 4–8 Re-positioning of both jaws affects the appearance of nasolabial area. That makes this particular region an important consideration when planning orthognathic surgery. 9,10 Patients with similar occlu- sion characteristics and skeletal values can have very different facial features due to differences in soft tissue characteristics; as such, evaluation of the nasolabial area must be performed during cephalometric examination. 11,12 Anomalous nasal deformities occur in as many as 61% of patients scheduled for orthognathic surgery. 13 Careful planning facilitates repairing nasal deformities and enhancing smiling while avoiding undesirable side effects. 14,15 Yet, sometimes undesirable deterioration of an aesthetic parameter is inevitable. Sun and Steinbacher reported 34.4% of their own study group, especially cases with significant maxillary movement, needed staged rhinoplasty after orthognathic surgery even with careful consideration of aesthetic parameters during planning pro- cess. 16 By predicting the probable effects of surgery on nasolabial area, informing the patient before the surgery for a possible suboptimal outcome (like a wide alar base to be widened after surgery) is possible. The literature includes many studies on the effects of orthog- nathic surgery on soft tissue, but the findings are inconsistent. 17–19 Every single patient’s surgical plan and soft tissue characteristics differ from each other and sample quantity needed for analysis increases as a result. Also, long follow-up period is needed for elimination of post-surgical edema. In addition, much of the rele- vant literature is based on dentistry, whereas only a few studies have examined changes in superficial topography or the parameters that are critical to aesthetic rhinoplasty. 17 For instance, to the best of our knowledge, no study has examined columellar-lobular angle or nasal tip symmetry as dependent variables. As such, the present study aimed to determine the effects of maxillary movements on nasal aesthetic parameters on a thorough basis. METHODS The records of patients that underwent orthognathic surgery at the Hacettepe University, School of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey, between January 2010 and December 2016 by a single surgeon (EK) were retrospectively reviewed. Patients had standard Le Fort I osteotomy with/without mandibular osteotomies was involved in the study. From the  Hacettepe University, School of Medicine, Department of Plastic Surgery; y Hacettepe University, School of Dentistry, Department of Orthodontics; z Hacettepe University, School of Medicine, Depart- ment of Biostatistics; and § Private Practice, Ankara, Turkey. Received June 9, 2019. Accepted for publication October 10, 2019. Address correspondence and reprint requests to Ersoy Konas¸, MD, Hacettepe Universitesi Hastaneleri Plastik Cerrahi AD Sekreterligi, 06100 Ankara, Turkey; E-mail: ersoykonas@gmail.com The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jcraniofa- cialsurgery.com). Copyright # 2020 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000006167 CLINICAL STUDY 796 The Journal of Craniofacial Surgery  Volume 31, Number 3, May/June 2020