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Abstract
Patients with a skeletal Class III deformity may present with a concave contour of the anteromedial cheek region. Le Fort I maxillary advancement and rotational movements correct the problem but information on the impact on the anteromedial cheek soft tissue change has been insufficient to date. This three-dimensional (3D) imaging-assisted study assessed the effect of surgical maxillary advancement and clockwise rotational movements on the anteromedial cheek soft tissue change. Two-week preoperative and 6-month postoperative cone-beam computed tomography scans were obtained from 48 consecutive patients who received 3D-guided two-jaw orthognathic surgery for the correction of Class III malocclusion associated with a midface deficiency and concave facial profile. Postoperative 3D facial bone and soft tissue models were superimposed on the corresponding preoperative models. The region of interest at the anteromedial cheek area was defined. The 3D cheek volumetric change (mm3; postoperative minus preoperative models) and the preoperative surface area (mm2) were computed to estimate the average sagittal movement (mm). The 3D cheek mass position from orthognathic surgery-treated patients was compared with published 3D normative data. Surgical maxillary advancement (all p < 0.001) and maxillary rotation (all p < 0.006) had a significant effect on the 3D anteromedial cheek soft tissue change. In total, 78.9%, 78.8%, and 78.8% of the variation in the cheek soft tissue sagittal movement was explained by the variation in the maxillary advancement and rotation movements for the right, left, and total cheek regions, respectively. The multiple linear regression models defined ratio values (relationship) between the 3D cheek soft tissue sagittal movement and maxillary bone advancement and rotational movements of 0.627 and 0.070, respectively. Maxillary advancements of 3–4 mm and >4 mm resulted in a 3D cheek mass position (1.91 ± 0.53 mm and 2.36 ± 0.72 mm, respectively) similar (all p > 0.05) to the 3D norm value (2.15 ± 1.2 mm). This study showed that both Le Fort I maxillary advancement and rotational movements affect the anteromedial cheek soft tissue change, with the maxillary advancement movement presenting a larger effect on the cheek soft tissue movement than the maxillary rotational movement. These findings can be applied in future multidisciplinary-based decision-making processes for planning and executing orthognathic surgery.
Highlights
The contour of the anteromedial cheek region has been considered as an important determinant of the overall aesthetics and youthfulness of the face [1,2,3]
The surgical maxillary mobilization, i.e., Le Fort I osteotomy, is a powerful therapeutic modality for a high number of patients who present with the skeletal Class III pattern associated with an anteromedial cheek deficiency and concave facial profile [12,13,14]
Most prior studies have focused on the impact of a specific type of surgical maxillary mobilization, i.e., maxillary advancement, on the facial soft tissue change [20,21,22,23,24,25,42,43,44], with the maxillary rotation receiving less attention to date
Summary
The contour of the anteromedial cheek region has been considered as an important determinant of the overall aesthetics and youthfulness of the face [1,2,3]. This cheek mass position has been considered as a standard metric for evaluating the anteromedial cheek contour [1,4,5], with the cheek point behind the cornea perpendicular line, i.e., a concave/deficient cheek contour, being considered a sign of ageing, exhaustion, and depression [4,5,7,8] This deficiency of the anteromedial cheek contour has been corrected by using different approaches, ranging from nonsurgical (different injectable filler materials) to surgical procedures (fat grafting, facial implants, and mobilization of an osteotomized maxillary bone segment) [9,10,11,12,13]. Quantitative data related to the impact of both maxillary advancement and rotational movements on the three-dimensional (3D) midface soft tissue change have been insufficient to date
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