Does Le Fort I Osteotomy Influence Nasal Septum Deviation?

Abstract

Le Fort I osteotomy is a technique for surgically correcting the maxillary position. Le Fort I osteotomy may affect the nasolabial structures since a very close relationship exists between the maxilla and the nose. This study aimed to investigate the effect of different maxillary movements on the nasal septum after Le Fort I osteotomies with cone beam computed tomography (CBCT) images. We hypothesized that nasal septal angle changes after maxillary impaction and advancement movements. This retrospective cohort study involved patients who underwent Le Fort I osteotomy to correct the maxillary position at Erciyes University, Oral and Maxillofacial Surgery Hospital. This study included patients who had CBCT images before (T0) and ≥12months after (T1) surgery. Patients with a history of septoplasty or rhinoplasty before orthognathic surgery, congenital deformities, or posttraumatic deformities were excluded. Its predictor variable was the direction and magnitude of the maxilla's vertical and horizontal movements. Change in septal deviation (in degrees) was the main outcome of the study. Age, sex, operation (Le Fort I alone or double jaw surgery), cartilage reduction, and anterior nasal spine reduction during surgery were covariates. Angle values were compared with independent samples t test or the Mann-Whitney U test in two-category variables. The Kruskal Wallis test was used to compare the angle values according to the movement. A P value of < .05 was considered statistically significant. This study evaluated 154 CBCT images of 77 patients (44 [57.1%] females and 33 [42.9%] males), of which 68 (88.3%) had double jaw surgery and nine (11.7%) had single Le Fort I surgery. The average nasal septum angle was significantly smaller preoperatively (166.2° [157.1° to 172.15°]) than postoperatively (168.7° [131.5° to 180.0°]) across subjects (P=.031). The septal angle decreased in 28 patients, and the rate of postoperative angular change was higher in patients with both advancement and impaction during the surgery (P=.014). Septum deviation can occur in 37% of cases after Le Fort I surgery. Therefore, Le Fort osteotomies are associated with changes in nasal appearance.