Changes In Nasolabial Angle Research Articles

Nasal profile changes after LeFort I osteotomy (maxillary advancement) with and without ANS reduction in class III skeletal patients: a study protocol for a randomized clinical trial

BackgroundDentofacial malformation is a common condition that affects a significant portion of the population, resulting in functional and aesthetic defects. Orthognathic surgeries, such as LeFort I osteotomy, are performed to correct these abnormalities. However, the impact of these surgeries on nasal profile changes remains unclear. Additionally, the role of anterior nasal spine (ANS) reduction in maxillary advancement surgeries of 3–5 mm range is yet to be determined. This study aims to investigate the effect of ANS reduction on soft tissue profile changes following LeFort I osteotomy with a maxillary advancement range of 3–5 mm in class III skeletal patients. The hypothesis is that the changes in nasolabial angle and upper lip length will not significantly differ between patients who undergo LeFort I osteotomy with and without ANS reduction.Method and designThis study is designed as a randomized controlled trial. A total of 26 class III skeletal patients with maxillofacial abnormalities will be recruited from the maxillofacial clinic of Bu-Ali and Farahikhtegan Hospitals in Tehran, Iran. Patients meeting the inclusion criteria will be randomly assigned to two groups: one group will undergo LeFort I osteotomy with ANS reduction, and the other group will undergo LeFort I osteotomy without ANS reduction. The soft tissue profile changes, specifically the nasolabial angle and upper lip length, will be evaluated and compared between the two groups.DiscussionAchieving facial harmony through orthognathic surgery requires careful planning and consideration of the impact on surrounding soft tissue. The primary objective is to predict and plan for the effects on the nasolabial region. LeFort I osteotomy is a common procedure used to correct dentofacial deformities, particularly in class III patients. Maxillary advancement during this surgery can lead to changes in nasal tip position, width, and rotation, potentially due to repositioning of the anterior nasal spine and soft tissue dissection. In this study, soft tissue changes will be assessed in non-growing class III patients using cephalometric radiographs. The impact of reducing the anterior nasal spine (ANS) on nasal profile changes will be investigated for maxillary advancements of 3–5 mm. Objective measurements and patient-reported outcomes will be evaluated to gain insights into the aesthetic outcomes of orthognathic surgery. The findings will provide valuable guidance for treatment decisions and alternative options based on expected nasal profile changes.Trial registrationThis project was registered at The Iranian Registry of Clinical Trials (Identifier No. IRCT20210928052625N1, Website: https://www.irct.ir/trial/59171) and Open Science Framework (OSF) (Registration https://doi.org/10.17605/OSF.IO/X3HD4). 2021-06-09.

Reconsidering the role of nasolabial angle in premolar extraction decision-making: A case-series study.

To evaluate the impact of changes in upper incisor inclination and position on the alteration of the nasolabial angle (NLA) in a series of cases involving the extraction of four first premolars. The study included 41 patients who underwent orthodontic treatment with premolar extractions. The patients were divided into two groups based on their pretreatment NLA values: Group 1 (NLA ≤ 100°) and Group 2 (NLA > 100°). Measurements of NLA, U1.NA and U1-NA were obtained before and after treatment and U1-Ls pretreatment measure was registered. Statistical analyses were performed to compare the differences in NLA, U1.NA and U1-NA between the two groups and to evaluate the influence of these variables added to U1-Ls (T1) on NLA changes. The results showed that Group 1 exhibited significant changes in NLA, while Group 2 did not. However, both groups showed significant changes in U1.NA and U1-NA. In Group 1, 80% of the individuals presented an increase in NLA and 20% no changes. In Group 2, 10% presented a decrease, 57% no changes and 33% an increase in NLA values. Multiple linear regression analysis indicated that the group factor had a statistically significant influence on NLA variation. Additionally, in Group 2, a negative correlation was observed between changes in U1.NA and NLA. The findings suggest that individuals with higher pretreatment NLA values tend to maintain their NLA values even after the correction of upper incisor inclination.

Evaluation of the Results of Septum Extension Batten Graft in Patients Referred for Septorhinoplasty.

Introduction Correction of caudal septal deviations has always been a challenging subject in septorhinoplasty. The septum batten extension graft (SBEG) is a new graft that has potential properties in rhinoplasty. However, few reports have evaluated the surgical outcomes of this technique. Objective The purpose of this study was to evaluate the effectiveness of SBEG in correcting caudal septal deviation. Methods This cross-sectional study was conducted on patients with caudal septal deviation undergoing septorhinoplasty using SBEG at 2 different hospitals in 2019. We then retrospectively reviewed medical records and photographs of 50 patients at the preoperative period, as well as at 1-month, and 12-month postoperatively. Gross changes in nasolabial angle, columellar show, nasal tip projection, and dorsal nasal deviation were evaluated by a photographic analysis method, and nasal obstruction was assessed by patient satisfaction with breathing. Results There was a significant difference between the mean nasolabial angle and columellar show at 1 and 12-months postoperatively, compared with the previous values ( p < 0.0001). The nasolabial angles were in a favorable position with an increase of 12 to 15 degrees compared with the preoperative state. The columellar show also improved by an average of 1.2 mm and was in good condition. The postoperative dorsal nasal deviation was significantly reduced, and projection was significantly increased (3.521 ± 0.087 mm vs. 0.719 ± 0.028; p < 0.0001; p < 0.001). Moreover, this method had a significant favorable effect on nasal obstruction ( p = 0.049). Conclusion Our results showed that septorhinoplasty using SBEG is useful for correcting caudal septal deviation, with favorable surgical outcomes, and it has responded well to all five aforementioned criteria.

Evaluation of the Results of Septum Extension Batten Graft in Patients Referred for Septorhinoplasty

Abstract Introduction Correction of caudal septal deviations has always been a challenging subject in septorhinoplasty. The septum batten extension graft (SBEG) is a new graft that has potential properties in rhinoplasty. However, few reports have evaluated the surgical outcomes of this technique. Objective The purpose of this study was to evaluate the effectiveness of SBEG in correcting caudal septal deviation. Methods This cross-sectional study was conducted on patients with caudal septal deviation undergoing septorhinoplasty using SBEG at 2 different hospitals in 2019. We then retrospectively reviewed medical records and photographs of 50 patients at the preoperative period, as well as at 1-month, and 12-month postoperatively. Gross changes in nasolabial angle, columellar show, nasal tip projection, and dorsal nasal deviation were evaluated by a photographic analysis method, and nasal obstruction was assessed by patient satisfaction with breathing. Results There was a significant difference between the mean nasolabial angle and columellar show at 1 and 12-months postoperatively, compared with the previous values (p &lt; 0.0001). The nasolabial angles were in a favorable position with an increase of 12 to 15 degrees compared with the preoperative state. The columellar show also improved by an average of 1.2 mm and was in good condition. The postoperative dorsal nasal deviation was significantly reduced, and projection was significantly increased (3.521 ± 0.087 mm vs. 0.719 ± 0.028; p &lt; 0.0001; p &lt; 0.001). Moreover, this method had a significant favorable effect on nasal obstruction (p = 0.049). Conclusion Our results showed that septorhinoplasty using SBEG is useful for correcting caudal septal deviation, with favorable surgical outcomes, and it has responded well to all five aforementioned criteria.

The Ram Graft: Using One Complete Piece of Conchal Cartilage for Nasal Tip Reconstruction in East Asians.

Adequate nasal tip projection remains a challenge in aesthetic rhinoplasty for East Asians. Various surgical techniques have been developed to reshape the nasal tip using auricular cartilage. In this article, we introduce the new ram graft to increase nasal tip projection by using one complete piece of conchal cartilage. Between 2019 and 2021, 19 patients who underwent nasal tip reconstruction using ram grafts were reviewed in a single hospital. The complication rate, satisfaction rate, and changes in nasolabial angle and nasal proportion were recorded. Nineteen patients with a mean age (± SD) of 28.9 ± 6.1 years underwent nasal tip reconstruction. The mean follow-up time was 15.4 ± 6.6 months. Nasolabial angle increased from 87.4 ± 10.0 degrees to 91.2 ± 10.2 degrees ( P > 0.05). Sixteen of 19 patients (84.2%) were satisfied with their results. The nasal length-to-nasal tip projection-to-dorsal height-to-radix height ratio is 2:0.8:0.62:0.19 preoperatively and 2:0.92:0.77:0.35 postoperatively. Complications including alloplast-related infection (two of 19) and septal extension graft-related decrease of nasal tip projection (one of 19) were recorded. By using one complete piece of conchal cartilage, the ram graft is a simple and effective approach to increase nasal tip projection for East Asians. Therapeutic, IV.

Improvement in Soft Tissue Profile &amp; Upper Airway Dimensions Following Forsus FRD – A Prospective Clinical Study

Aim: To assess improvement of soft tissue profile and upper airway dimensions in skeletal Class II adolescent patients treated with Forsus Fatigue Resistant Device (FRD). Material and Methods: This prospective observational study was planned with a sample size of 15 subjects (5 male &amp; 10 female) diagnosed with mandibular hypoplasia as a cause of Class II malocclusion, requiring fixed functional therapy, with the inclusion criteria of age of 16-25 yrs with the ANB value range of 4°+2° with a non-extraction treatment plan. Pre-functional records were recorded once the leveling and alignment phase was complete and Forsus FRD attachments were placed. Treatment continued till the desired objectives were achieved. Post functional records were made at the end of functional therapy, after removal of Forsus FRD. Along with soft tissue analysis on lateral cephalogram, Acoustic Pharyngometry (AP) was recorded for each patient (Eccovision®” (sleep group solutions Florida, US) for airway changes before and after Forsus FRD. Results: Post functional treatment indicated statistically significant changes in nasolabial angle, upper lip position, upper lip strain, H angle and mento-labial sulcus. On evaluation of upper airway dimensions of the subjects by pharyngometry , there were statistically significant changes in mean upper airway volume and area. Conclusion: Study concluded that Forsus FRD is an effective method for correction of skeletal Class II malocclusion among adolescent patients, enhancing marked improvement in soft tissue profile of the patients, along with significant increase in volume and area of hypopharyngeal and oropharyngeal spaces, thus improving the upper airway patency.

A Perioral Soft Tissue evaluation after Orthognathic Surgery Using Three-Dimensional Computed Tomography Scan.

Background:Facial appearance is an important factor, affects social and psychological well-being. The ideal positioning of jaws and soft tissues is crucial during orthognathic surgery for a better outcome, but the response of facial soft tissues does not always reflect the exact movements of the underlying jaws in 1:1 ratio. So, soft tissue changes following orthognathic surgery require utmost attention during surgical correction to make successful treatment.Aims and Objectives:Evaluation of perioral soft tissue changes after orthognathic surgical procedures. The objectives of the study were to assess and compare pre and post-operative perioral soft tissue changes of lip width, nasolabial and mentolabial angle using Three Dimensional Computed Tomography scan (3DCT).Patient and Methods:The study involved ten patients for evaluation requiring orthognathic surgical procedures (maxillary or mandibular anteroposterior excess or deficiency, transverse deformities, vertical maxillary excess and facial asymmetry) presented to the department of oral and maxillofacial surgery during 2014-2016. Pre and post-operative 3DCT scan were taken after 12 months using iCT 256 slice whole body CT scanner and evaluated for changes using Dicom PMS D view.Results:Significant changes were observed in nasolabial angle after maxillary advancement (1.81°) and maxillary setback procedure (2.73°). The mentolabial angle was significantly increased with mandibular setback procedures (3.27°). Mandibular advancement procedures showed both increase (3.6°) and decrease (7.6°) in mentolabial angle.Conclusion:3DCT showed a significant difference in perioral soft tissue changes in nasolabial and mentolabial angle but no significant change was observed in lip width. 3DCT is a reliable tool for 3D assessment. The conventional thought of changes in Nasolabial angle after surgery is changing due to the underlying factors which should be considered for prediction.

A Three-Dimensional Study of Midfacial Changes Following Le Fort II Distraction With Zygomatic Repositioning in Syndromic Patients.

Le Fort II distraction with zygomatic repositioning introduced the ability to restore central midfacial height and convexity independent of changes in orbital morphology. This study analyzes midfacial and orbital morphology before and after Le Fort II distraction with zygomatic repositioning.All patients who underwent Le Fort II Distraction with zygomatic repositioning between 2013 and 2015 were included. Two- and 3-dimensional measurements were made using 3dMD Vultus software to assess canthal tilt, nasolabial angle, ratio of midfacial to lower facial height, and absolute change in nasal length. Presence of an open bite and Angle classification were assessed before and after surgery.Four patients underwent segmental midface advancement using Le Fort II distraction with zygomatic repositioning. Associated diagnoses included Apert syndrome, Goldenhar syndrome, and achondroplasia. Changes in facial dimensions included: 3.19° improvement in canthal tilt (range -4.7° to 8.4°), 9° change in nasolabial angle (range -1.0° to 19°), and 0.69 cm increase in absolute nasal length (range 0.2-0.94 cm). Mean ratio of midfacial to lower facial height was 0.79 preoperatively and 0.89 postoperatively. Preoperatively, all patients demonstrated Angle class III with 3 of 4 patients demonstrating anterior open bite. All achieved closure of open bite and demonstrated class I or II occlusion. No complications were observed.Le Fort II distraction with zygomatic repositioning resulted in normalization of midfacial soft tissue landmarks. This form of advancement demonstrates the ability to selectively improve midfacial height and canthal tilt while restoring normal occlusion.

Cephalometric Evaluation of Facial Soft Tissue Changes after Orthodontics and Bimaxillary Orthognathic Surgery Treatment in Patients with Skeletal Class III Discrepancy

Background Severe skeletal class III malocclusions usually need a combined treatment of orthodontics and orthognathic surgery. Knowing about changes occurred following such treatments lead to improve facial esthetics and better treatment results. Objectives This study was done to determine cephalometric changes of facial soft tissue after combined treatment in patients with skeletal class III problem. Methods 25 patients with skeletal class III discrepancy who needed a combined treatment, were selected. Changes in nasolabial angle , upper lip and lower lip to E-line distance, angle of convexity , lip-chin-throat angle and lower anterior facial height were measured before and 6 - 12 months after surgery. Changes in parameters were analyzed with Paired t-test. Results Upper lip to E-line distance (P < 0.0001) and angle of convexity (P < 0.001) changed significantly following surgical procedures while changes of other parameters were not significant. Conclusions Clinical changes in the soft tissue following a combination of orthodontic treatment and orthognathic surgery in patients with skeletal class III discrepancy are significant while these changes mostly improves esthetics of patient’s facial profile.

Profil jaringan lunak wajah kasus borderline maloklusi klas I pada perawatan ortodonti dengan dan tanpa pencabutan gigi (Facial soft tissue profile on borderline class I malocclusion in orthodontic treatment with or without teeth extraction)

Background: Determination of orthodontic treatment plan with or without teeth extraction remains controversial, especially in borderline cases, so it requires more data and information to establish appropriate treatment plans in order to obtain optimal treatment results. Purpose: The study was aimed to determine the facial soft tissue changes in the borderline class I cases treated with and without tooth extraction on post-orthodontic treatment. Methods: The study was conducted on 28 lateral cephalograms, divided into two groups; 13 cases with tooth extraction, and 15 cases without tooth extraction. The subject criterias were as follows; class I malocclusion treated with straightwire technique, skeletal class I, in range of age between 18 to 30 years old, normal overjet 2-4 mm, arch length discrepancy between 2.5 to 5 mm, Index of Fossa Canine (IFC) between 37% to 44%, did not using extraoral devices, and treated with teeth extraction of 4 second premolars or without tooth extraction. The measurement of nasolabial angle, labiomental angle, and linear position of the upper and lower lip to E-Ricketts line were done on each cephalogram before and after orthodontic treatment. Results: In teeth extraction cases, there was a change on upper and lower lips positions (p 0.05). In non teeth extraction cases, there were no changes in nasolabial angle, labiomental angle, and lips positions (p>0.05). Both of groups also have indicated that there were no changes on linear position of the upper and lower lip (p>0.05). Post-orthodontic treatment indicated a significant differences between extraction and nonextraction cases on nasolabial and labiomental angle, and lips position (p 0,05). Pada kelompok tanpa pencabutan tidak terdapat perubahan pada sudut nasolabial, sudut labiomental, dan posisi bibir (p>0,05). Terdapat perbedaan sudut nasolabial, sudut labiomental, dan posisi bibir antara kelompok dengan pencabutan dan tanpa pencabutan sesudah perawatan ortodonti (p<0,05). Simpulan: Profil jaringan lunak wajah kelompok yang dirawat dengan pencabutan gigi menjadi lebih retrusi daripada profil jaringan lunak wajah kelompok yang dirawat tanpa pencabutan.

Caudal Resection of the Upper Lateral Cartilages and Its Measured Effect on Tip Rotation

Commonly used maneuvers for upward tip rotation include cephalic trim of the lateral alar cartilages, caudal resection of the septum, and shortening of the upper lateral cartilages (ULCs). Few techniques for surgical manipulation of the ULCs are found in the literature, and none accurately describe the measured effect of the caudal resection on tip rotation. The purpose of this study is to predict the change in upward rotation of the nasal tip for a measured incremental resection of the ULCs. Ten fresh cadaveric noses were dissected with the aid of loupe magnification via an open rhinoplasty approach. The ULCs were sectioned in 20% increments, and measurements of the nasolabial angle (NLA) were recorded with the use of a goniometer. True lateral photographs were obtained for the photographic analysis of the specimens. The average length of the ULC was 16.8 ± 1.6 mm. Serial reduction of the ULC length by 4 sequential 20% increments resulted in a mean NLA change of 3.6, 2.7, 2.1, and 1.9 degrees, respectively. The average incremental change in NLA for the 4 resections was 2.6 degrees. Caudal resection of the ULC has a measurable effect on the upward rotation of the nasal tip. A 20% resection correlates with an average change in the NLA of 2.6 degrees. Because caudal resection of the ULC is a powerful tool in the armamentarium of the rhinoplasty surgeon that can cause narrowing of the internal nasal valve and hallowing of the lower nasal sidewalls, it should be used with caution in a selected group of patients when attempting to elevate the "droopy" tip.

Retrospective Analysis of Nasal Soft Tissue Profile Changes With Maxillary Surgery

The aim of this study was to analyze the changes in the position of the nasal and labial soft tissue profile of patients undergoing bimaxillary orthognathic surgery, with special emphasis on the effect on the nasal tip projection. The lateral cephalometric radiographs of 27 consecutive patients (16 female and 11 male patients; mean age, 22 years) who had undergone maxillary advancement and mandibular setback were studied. The pretreatment and end-of-treatment lateral cephalometric radiographs were selected. The pretreatment and end-of-treatment radiographs were superimposed on the sella-nasion plane, and the case was only included if there had been no change in sella-nasion length (ie, no growth). Analyses of Pearson correlation coefficient and stepwise linear regression tests were used to compare the cephalometric measurements at the beginning and at the end of treatment. Paired-sample t tests were also performed to analyze changes in nasolabial angle (NLA) and columella-lobular angle (CLA). The correlations between vertical movement of nasal tip, A-point, and maxillary incisal tip were important. Although there was an important correlation between nasal and incisal tip, interestingly, there was no correlation between nasal tip and A-point in horizontal movement. According to stepwise linear regression analysis, the best model for horizontal movement of nasal tip was as follows: Nasal anteroposterior movement = 0.241 + 0.188 × Incisal tip anteroposterior movement + 0.153 × Incisal tip superoinferior movement. For vertical movement of nasal tip, the best model was as follows: Nasal superoinferior movement= -1.117 + 0.399 × Incisal tip superoinferior movement + 0.323 × A-point anteroposterior movement. There was no significant relation in angular measurements of NLA and CLA before and after treatment. The results of our study suggest that both horizontal and vertical movements of nasal tip were related to incisal tip and A-point movements; however, angular changes in CLA and NLA did not affect the nasal tip.

Soft tissue changes of the upper lip associated with maxillary advancement in obstructive sleep apnea patients

Purpose: This retrospective study evaluated the horizontal and vertical soft tissue changes that occur with maxillary advancement surgery with a Le Fort I osteotomy with concomitant anatomic reorientation of the nasolabial musculature. Subjects and Methods: Fifteen OSA patients who underwent maxillary advancement with a Le Fort I osteotomy without adjunctive nasal soft tissue procedures were studied after a minimum of 8 months of follow-up. The V-Y technique was used to close the maxillary vestibular incision. Only cases with minimal vertical movement (< 3.5 mm) in which no orthodontics were used were included. The average maxillary advancement was 8.0 ± 2.5 mm, measured at the upper incisor (UPI) and the average vertical movement was 0.7 ± 1.8 mm. The horizontal and vertical soft tissue change in subnasale (SN), labrale superiorus (LS), superior stomion (SS), nasal tip (NT), nasolabial angle (NLA), and lip length were measured in each patient and correlated with hard tissue measurements at anterior nasal spine (ANS) and UPI. The effect of lip thickness on these soft tissue changes also was evaluated. Results: Using mean data, the horizontal soft-to-hard-tissue ratio for LS to UPI was 0.80:1, with a concomitant vertical (superior) soft tissue change to hard tissue advancement of 0.16:1. Lip length did not change significantly. All patients except 1 showed a slight decrease in nasolabial angle. The average decrease was 5° (range, −10° to +7°). There was no statistically significant correlation between the degree of change in NLA and the amount of maxillary advancement. Conclusion: This study showed that advancement of the maxilla when controlling vertical movement resulted in the a hard-to-soft-tissue ratio of LS:UPI of 0.80:1. NLA did not change significantly. © 2001 American Association of Oral and Maxillofacial Surgeons

The relationship between hard and soft tissue changes following treatment of Class II division 1 malocclusions using Edgewise and Frankel appliance techniques

Lateral-skull radiographs were used to examine the hard and soft tissue changes following overjet reduction in 62 children with moderately severe Class II division 1 malocclusions. Thirty-two patients were treated by non-extraction methods using Fränkel appliances, and the remainder by a standard Edgewise technique involving extractions and extra-oral traction. The relationships between changes in upper and lower lip positions, naso-labial angle, and labiomental fold with those in the underlying dento-skeletal elements were examined. The ratio between movement of the upper lip prominence and upper incisor crown was also calculated. Finally, the patterns of correlation between the two groups were compared. Both Spearman and partial correlations were calculated. The latter were used in an attempt to separate the true treatment effects from those of growth. This reduced the number of significant correlations considerably, 'sharpening' the results so that expected levels of agreement were enhanced, whereas spurious results were reduced. Few correlations reached a level of r = 0.7 or above. Incisor retraction was correlated with upper lip movement at this level only in the Edgewise group. No correlations were found between changes in naso-labial angle, labio-mental fold, and their underlying hard tissues. The Spearman correlations largely agreed with those of other authors, indicating that most of their apparently concordant hard and soft tissue movement was due to growth rather than appliance therapy. The use of ratios to compare upper lip and maxillary incisor retraction was not relevant in the functional appliance group because the average lip change was very small. It is concluded that the relationship between hard and soft tissue movement is too complex to be examined in a relatively simplistic way.

Changes in nasolabial angle related to maxillary incisor retraction

Changes in the nasolabial angle of the soft-tissue profile were assessed quantitatively in a serial cephalometric study of fifty treated subjects and forty-three untreated subjects, all of whom had Class II, Division 1 malocclusions. Correlations, simple and multiple regression analyses, and multifactorial analysis of variance were used to examine the changes in the nasolabial angle owing to incisor superius retraction and associated skeletal displacements. There were no significant changes in nasolabial angle because of growth. However, the greater the maxillary incisor retraction, the greater was the increase in nasolabial angle. Increase in the nasolabial angle showed a significant correlation with treatment-related increase in the vertical dimension of the lower face. The soft-tissue profile followed closely the underlying skeletal framework. Extraction and nonextraction treatment procedures did not show significant differences in the changes of the nasolabial angle. Results permit prediction of the changes in nasolabial angle owing to incisor superius retraction in orthodontic treatment.