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The Impact of LeFort I Advancement and Widening on Nasiolabial Morphology
Christopher DeSesa, DMD, Rajendra Sawh-Martinez, MD, Robin Wu, BA, Philipp Metzler, DMD, MD, Derek Steinbacher, DMD, MD.
Yale-New Haven Hospital, New Haven, CT, USA.

BACKGROUND:Le Fort I osteotomy imparts significant changes to the nasolabial region. Past studies have relied on 2-dimensional (2D) data, and have not adequately distinguished between various LeFort I subtypes. The purpose of this study is to 3-dimensionally (3D) analyze the changes to the nose and lip following LeFort I comparing single-piece, expanded segmental, and surgically assisted expansion (SAME). We hypothesize that
the type and magnitude of movement will influence the nasolabial morphology.
METHODS: A retrospective cohort study was performed. Included LeFort-I patients were grouped as:1) non-segmental straight advancement, 2) segmental with advancement and widening, 3) surgically assisted expansion, without advancement. 3D photos (Canfield, Fairfield NJ) from preoperative
and greater than 6-months post-procedure were analyzed. Anthropometric landmarks were placed and measured by two independent observers. Statistics involved both paired and unpaired t
tests (significance = P <0.05).
RESULTS: 108 photogrammetric datasets were analyzed, including 46 single piece, 36 segmental, and 26 SAME. The male-to-female ratio was 0.5 (mean age, 23.5). Mean advancement was 5.8 (± 1.8) and 5.6 (± 2.3) for the single-piece and segmental groups respectively. Significant postoperative nasal changes were observed within each intragroup analysis. Cross-group analysis demonstrated the greatestincrease in alar base width (Δ3.9 ± 1.6), alar width (Δ4.5 ± 1.4), nostril width (Δ1.6 ± 0.7), and soft triangle angle (Δ11.1 ± 4), all P < .05. Nasofrontal angle decreased within the single-piece group, while philtral width increased only among the
Dramatic nasolabial changes occur following LeFort I osteotomy. The 3D changes are discrete and differ depending on the osteotomy group subtype. This objective understanding permits more accurate surgical planning and patient counseling

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