Three dimensional evaluation of soft tissue after orthognathic surgery
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RESEARCH
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Three dimensional evaluation of soft tissue after orthognathic surgery Junho Jung, Chi-Heun Lee, Jung-Woo Lee and Byung-Joon Choi*
Abstract Background: To evaluate the nasolabial soft tissue change three-dimensionally after orthognathic surgery, using a structured light scanner. Methods: Thirty-two malocclusion patients, who underwent orthognathic surgery, were evaluated. CBCT and 3D facial scans were obtained before surgery and 3 months after surgery. The 3D changes in the 26 landmarks, and the relative ratio of the soft tissue movement to the bony movement, were evaluated. Results: In the Le Fort I advancement patients, the nasal tip moved 17% forward, compared to the maxillary bony movement, but the nasal prominence decreased 15%. The alar width increased 4 mm after the advancement, and the width decreased 4.7 mm after Le Fort I setback. The relative ratio of the soft tissue movement to the bony movement after bilateral sagittal split osteotomy was about 66% at the Li point in the anteroposterior direction, and it was 21% in the Le Fort I advancement and 14% in Le Fort I setback at the Ls point. Conclusion: Alar cinch suturing may not be sufficient to overcome the effect of the maxilla advancement compressing the nasal complex. Alar width widening was prevented in Le Fort I setback. However, it is uncertain that the alar cinch suturing was solely responsible. The soft tissue around the mandible tends to accompany the bony movement more than the maxillary area. In addition, structured light scanning system proved to be a useful tool to evaluate the nasolabial soft tissue. Keywords: Orthognathic surgery, Structured light-based scanners, 3D measurement, Nasolabial soft tissue
Background Orthognathic surgery restores not only the occlusal function, but also aesthetics by improving facial harmony. Needless to say, improving soft tissue esthetics is of the ultimate treatment goal. According to skeletal movements from orthognathic surgery, there are consistent nasolabial soft tissue changes. Consequently, various attempts have tried to establish a correlation between the hard and soft tissue changes [1–4]. Conventional two-dimensional (2D) lateral cephalogram is used to predict and evaluate surgical outcomes before and after surgery. Although these methods are convenient and have economic advantages, due to the limitation of its midsagittal projection and the projection angle and distance, the information of soft tissue changes and the accuracy is lacking and unsatisfactory [5]. Moreover, since * Correspondence: [email protected] Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, 02447 Seoul, Republic of Korea
various soft tissue closure techniques, including the alar cinch suture and the “V-Y” lip mucosal closure, control the nasal base and upper lip [6–8], 2D imaging methods may not be adequate to evaluate the nasolabial tissue. In recent years, 3D imaging has gained popularity to overcome the limitations of 2D analysis.
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