Abstract
Studies of orthognathic surgery often focus on pre-surgical versus post-surgical changes in facial shape. In contrast, this study provides an innovative comparison between post-surgical and control shape. Forty orthognathic surgery patients were included, who underwent three different types of surgical correction: Le Fort I maxillary advancement, bilateral sagittal split mandibular advancement, and bimaxillary advancement surgery. Control facial images were captured from volunteers from local communities in Glasgow, with patterns of age, sex, and ethnic background that matched those of the surgical patients. Facial models were fitted and Procrustes registration and principal components analysis used to allow quantitative analysis, including the comparison of group mean shape and mean asymmetry. The primary characteristic of the difference in shape was found to be residual mandibular prognathism in the group of female patients who underwent Le Fort I maxillary advancement. Individual cases were assessed against this type of shape difference, using a quantitative scale to aid clinical audit. Analysis of the combined surgical groups provided strong evidence that surgery reduces asymmetry in some parts of the face such as the upper lip region. No evidence was found that mean asymmetry in post-surgical patients is greater than that in controls.
Highlights
Studies of orthognathic surgery often focus on pre-surgical versus postsurgical changes in facial shape
Bonferroni correction for multiple testing led to a reference of 0.05/10 = 0.005, which highlights the third principal components (PCs) as the source of shape differences between the female patients who had undergone maxillary Le Fort I osteotomy and the control cases
The most significant finding of this study is the residual mandibular prognathism that was detected in the group of patients who had undergone Le Fort I osteotomy for the correction of maxillary retrognathism
Summary
Studies of orthognathic surgery often focus on pre-surgical versus postsurgical changes in facial shape. Registration of pre- and post-surgical radiographs allows both bone and soft tissue changes to be quantified[1]. There are no standardized outcome measures to assess the soft tissue changes produced following orthognathic surgery. Previous studies have reported on soft tissue changes between pre-surgery and post-surgery facial shapes. Very few studies have reported on the outcome of surgery in comparison to a ‘normal’ reference group[7]. This distinction is important, as the elective surgical procedure, driven predominantly by aesthetics, should result in a ‘peer-acceptable’ facial soft tissue appearance. The primary aim of the study reported here was to compare groups of post-surgical patients with a sample of controls
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