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Clockwise and counterclockwise Le Fort I movements influence nasolabial morphology differently.
Rajendra Sawh-Martinez, MD, Christopher DeSesa, DMD, Robin Wu, BA, Derek Steinbacher, MD, DMD.
Yale School of Medicine, New Haven, CT, USA.

Le Fort I advancement impacts nasal appearance. However, no data exists assessing 3D nasal change following anterior (counterclockwise, CCW) or posterior maxillary impaction (clockwise, CW) during Le Fort I osteotomy. The purpose of this study was to analyze nasolabial changes comparing CW to CCW maxillary movements.
This was a retrospective cohort study of patients undergoing single-piece Le Fort I advancements. Patients were split into two groups: CCW and CW. Pre- and postoperative 3D photographs (Canfield, Fairfield, NJ) were captured and anthropometric measurements were performed (>6mo postoperative). Two observers verified each landmark. Statistical analysis involved paired t test for comparison of numerous pre- and postoperative nasolabial measurements for each patient in each group.
Thirty patients were evaluated, 15 per group. CCW had statistically significant increases in alar width (3.6mm, P<0.001), alar base width (1.6mm, p=0.009), oral width (3.1mm, P=0.02), and lip projection (+3.3mm, P=0.04). The subnasion projection (2.3mm, p=0.08) and columella width (0.58mm, P=0.9) demonstrated trends toward significant increases. There were decreases in the nasofrontal angle (-3.05mm, p=0.10), nasolabial angle (-3.2mm, p=0.5), nostril height (-0.68mm, p=0.24), columella height (-0.11mm, p=0.88), philtrum height (-0.08, p=0.94) but these did not achieve statistical significance. CW changes were not statistically significant. However, the largest changes in positions were noted in alar width (2.7mm, p=0.07) and alar base width (1.7mm, p=0.09). Decreases in the nasofrontal angle (-2.36, p=0.37), nostril height (-0.9mm, p=0.09), and columella height (-0.8mm, p=0.31) were noted.
3D nasolabial changes are more marked for CCW movements. This study suggests that soft-tissue nasolabial changes following Le Fort I are more complex than previously thought, and occlusal plane alteration significantly influences nasal form.

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