Orthognathic surgery and rhinoplasty: Should they be simultaneous or staged?
Alexander H. Sun, BS, Derek M. Steinbacher, DMD, MD.
Yale School of Medicine, New Haven, CT, USA.
BACKGROUND: Orthognathic surgery can have significant effects on the nasolabial envelope, which may or may not be desirable. At times, a simultaneous or a staged rhinoplasty is required as an adjunctive procedure. The purpose of this study is to evaluate the nasal morphology in a large cohort of orthognathic patients, focusing on predictive variables, and need for and timing of definitive rhinoplasty. Based on this data, an algorithm for implementation of adjunctive rhinoplasty in orthognathic patients will be proposed.
METHODS: This is an IRB-approved review of orthognathic cases over a two-year period. Demographic, diagnostic, and operative details were compiled, as well as information about nasal morphology and requirement/timing of rhinoplasty. Three-dimensional images (Canfield Scientific, Parsippany, NJ) were used to quantify the anatomic variables. Two-tailed z-tests were used to compare proportions with an alpha of 0.05.
RESULTS: A total of 227 patients underwent orthognathic surgery during this time period; 163 fulfilled inclusion criteria for this study. The mean age was 23.3 years. Patients without rhinoplasty either had no intrinsic deformity or had improved results with orthognathic surgery alone. In total, 41.7% of orthognathic cases received an adjunctive rhinoplasty. Of these, 82.4% were staged and 17.6% were simultaneous. The average time between staged procedures was 208 days. When simultaneous, 83.3% of the orthognathic procedures had little to no maxillary movement (advancement <4-5mm, impaction <2mm, no alar base excisions); in comparison, only 7.1% of staged cases had little maxillary movement (p<0.0001).
CONCLUSIONS: Nasal and jaw deformities are intricately interlinked. In this large series, we identified a 44.2% prevalence of nasal deformity (72/163). The specifics of orthognathic movement, and presence/absence of intrinsic nasal deformity influenced the need for rhinoplasty. When rhinoplasty is indicated, it can be simultaneous or staged. Concurrent nasal surgery is best for cases with minimal maxillary manipulation. On the other hand, interval rhinoplasty is recommended for preexisting nasal deformities, or orthognathic-induced or worsened nasal problems.
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