Nasolabial Changes Research Articles

A Longitudinal Investigation of Nasolabial Changes With and Without Revision Surgery in Patients with Non-Syndromic Unilateral Cleft Lip and Palate.

To determine a baseline of anticipated change in nasolabial appearance following primary repair of unilateral cleft lip/palate and evaluate the degree to which revision surgery improves nasolabial appearance. Retrospective chart review. Patients treated at the Lancaster Cleft Palate Clinic interdisciplinary clinic. Twenty-three patients with complete unilateral cleft lip and palate who underwent primary surgical repair and 19 additional patients who underwent subsequent revision surgery were included. Patients in the non-revision group underwent a Tennison-Randall triangular flap lip repair at 3mo. Patients in the revision group underwent a modification of the Nakajima straight-line repair after primary Tennison-Randall triangular flap lip repair at an average age of 141mo. A modification of the Asher-McDade Aesthetic Index was utilized to evaluate Nasolabial Frontal (NLF), Nasolabial Profile (NLP), Vermillion Border (VB), and total change in appearance. Scores for patients in the revision group were evaluated before and after revision while appearance for patients without revision was evaluated at 3 distinct ages. Scores were averaged across time-points and inter-rater reliability was assessed. Nasolabial appearance in the non-revision sample did not change significantly over time, except for nasal profile. Scores improved after revision surgery - NLP: 3.48 to 2.97, (p = 0.001); NLF: 3.50 to 2.95 (p = 0.001); and Total Nasolabial Score: 3.29 to 3.01 (p = 0.004), with no significant change in VB. Decisions regarding need for nasolabial revision surgery may be made as early as 5yo with successful outcomes following secondary surgery improving appearance except for vermillion border appearance.

The influence of tissue redraping after Le Fort I type osteotomy

Elongation of the upper lip, in particular the philtrum, and nose widening are common postoperative changes after a Le Fort I osteotomy. These changes can be induced by the transection of soft tissue and loosening of the underlying musculature. A methodology for soft tissue redraping was developed to limit these undesirable nasolabial changes. This study evaluates the effectiveness of the technique and influence of maxillary translocation on the nasolabial form. Anthropometric measurements, lip, philtrum length, and nose width, were taken two weeks prior to, and one year after, surgery. The mean postoperative changes were minimised to less than 1mm except for lip length in the extrusion groups, which was less than 1.5mm. Statistical analysis showed a stable result for lip length after maxillary advancement and/or intrusion as limited lengthening mainly occurred at the vermilion. Conversely, lip lengthening after extrusion mainly occurred at the philtrum. The mean nose width was maintained after maxillary advancement, decreased after extrusion, and increased after intrusion. The type of maxillary translocation only influenced the nasolabial soft tissue in case of intrusion and extrusion, not after advancement.

Three-dimensional nasolabial changes after maxillary advancement osteotomy in class III individuals: a systematic review and meta-analysis.

Background Class III malocclusions with maxillary retrognathia are commonly treated with single jaw Le Fort I maxillary advancement. The three-dimensional (3D) effects of surgery on the nasolabial region varies among the clinical studies. Quantifying these changes is of great importance for surgical planning and obtaining valid consent. Objectives To investigate the 3D relationship between soft tissue and skeletal changes secondary to Le Fort I maxillary advancement surgery in skeletal class III patients.Search methods Comprehensive search of multiple electronic databases supplemented by a manual and grey literature search were undertaken from inception to 9 June 2020.Selection criteria Studies that evaluated the 3D soft tissue changes of patients before and after maxillary advancement surgery alone.Data collection and analysis Study selection, data extraction and risk of bias assessment were performed independently by two reviewers, with disputes resolved by a third reviewer. A quantitative synthesis of the data was pre-planned for pooling similar outcome measures.Results Four studies were included in the final review and meta-analysis, with a total of 105 patients (mean age 16.7 + 33.9 years). The mean maxillary advancement of the included studies was 5.58 mm (95% CI 5.20-5.96). The sagittal effects of surgery on nose tip projection and prominence were insignificant (P >0.05, two studies); however, subnasal projection (MD 1.7 mm, two studies) and upper lip projection (MD 2.90 mm, four studies) increased significantly in a forward direction after surgery (P <0.05). Le Fort I osteotomy widens the upper philtrum width (MD 0.84 mm, two studies) (P <0.05). Inconsistencies among the included studies were identified; therefore, the results should be interpreted with caution.Conclusions There is weak evidence based on quantitative assessments that Le Fort I maxillary advancement significantly affects the nasolabial soft tissue envelope mainly in a sagittal dimension. These changes are concentrated around the central zone of the nasolabial region. Future prospective studies on maxillary advancement osteotomy with a standardised method of assessment, taking into consideration the confounding factors, are required.

Three-Dimensional Nasolabial Changes After Nasoalveolar Molding and Primary Lip/Nose Surgery in Infants With Bilateral Cleft Lip and Palate.

Utilize 3-dimensional (3D) photography to evaluate the nasolabial changes in infants with bilateral cleft lip and palate (BCLP) who underwent nasoalveolar molding (NAM) and primary reconstructive surgery. This is a retrospective serial longitudinal study of consecutively enrolled infants from September 2012 to July 2016 with BCLP who underwent NAM before primary lip and nose reconstructive surgery. It included infants who had digital 3dMD stereophotogrammetry records at initial presentation (T1), completion of NAM (T2), and 3 weeks following primary repair (T3). Twelve infants fulfilled the inclusion criteria. 3dMD Vultus software was used to orient images and plot 16 nasolabial points with x, y, z coordinates to obtain the linear and angular measurements. Nasal form changes were measured and analyzed between T1 (0.5 months old), T2 (5 months old), and T3 (6 months old). Intraclass correlation coefficient was performed for intrarater reliability. Averaged data from the 3D images was statistically analyzed from T1 to T2 and T2 to T3 with Wilcoxon tests. Unaffected infant norms from the Farkas publication were used as a control sample. After NAM therapy, statistically significant changes in the position of subnasale and labius superius improved nasolabial symmetry. Both retruded after NAM were displaced downward after NAM and surgical correction with respect to soft tissue nasion. The nasal tip's projection was maintained with NAM and surgical correction. The columella lengthened from 1.4 to 4.71 mm following NAM. There was a significant improvement in the nasolabial anatomy after NAM, and this was further enhanced after primary reconstructive surgery.

Nasolabial Changes Following Double Jaw Surgery.

This study aimed to analyze 3-dimensional nasolabial soft tissue changes following double jaw surgery with Le Fort I maxillary advancement and relate them to underlying surgical movements. Pre- and post-surgical cone-beam computed tomography images of 37 maxillomandibular surgery patients with ≥2 mm of advancement at A-point were analyzed. Lateral cephalograms were constructed to determine horizontal and vertical surgical movements and 3-dimensional facial images were created from the CBCTs to calculate linear and angular changes. Alar base width increased 1.9 mm, nasal tip protrusion decreased 0.74 mm, the upper lip flattened 7.71 degree and increased 0.9 mm in length, nasal tip was displaced 2.47 mm superiorly causing an increased concavity of 5.52 degree for the overall dorsal surface and 3.99 degree at the supratip break angle (SBA), nasal tip angle decreased 2.16 degree and nasolabial angle decreased 7.37 degree. Correlations were found between underlying surgical movements and nasal tip protrusion, SBA, nasolabial angle (NLA), and nasal tip elevation (NTE). Multiple linear regression equations were calculated to predict changes in SBA from horizontal change at A-point, NLA from horizontal change at B-point, and NTE from the change at A-point horizontally and U1-tip vertically. Double jaw surgery with maxillary advancement has significant effects on nasolabial anatomy.

Three Dimensional Evaluation of Nasolabial Changes Following Classic vs Without Alar Base Suture After Le Fort I Osteotomy

Three Dimensional Evaluation of Nasolabial Changes Following Classic vs Without Alar Base Suture After Le Fort I Osteotomy

Dynamic Nasolabial Growth After Primary Surgery for Patients With Bilateral Cleft Lip: A Five-Year Follow-Up Study

Bilateral complete cleft lip (BCCL) causes severe tissue deficit and usually requires multiple revisions after primary repair. In the present study, we aimed to illustrate the nasolabial changes after primary BCCL correction. The present retrospective cohort study compared patients who had undergone BCCL and palate (BCCLP) and cleft palate only (CPO). All included patients had undergone surgery at the same treatment center (West China Hospital of Stomatology) from 2007 to 2012. The patients returned for follow-up surgery at 6months and 5years after their primary repair surgery. We retrieved the facial plaster casts of the enrolled patients and recorded the key nasolabial measurements. The outcome variables included the prolabial length (PL), peak distance, nasal width, and columellar length (CL). The data were analyzed using a general linear model for repeated measures, and the linear association was tested using SPSS. The level of testing efficiency (P value) was set at .05. A total of 160 patients, 80 who had undergone BCCLP and 80 CPO controls, were included. All nasolabial measurements in the BCCLP group had increased during the 5-year follow-up period. The PL of the BCCLP group had increased more quickly than the PL of the CPO group (P=.000<.05), but the CL had increased nearly as much (P=.270). For the primary correction of bilateral cleft lip nose deformity, dissection and repositioning of the cleft lip and nose did not significantly inhibit the growth of the nasolabial region in the first 5years after surgery. Nose deformities should not remain uncorrected after primary surgical repair. In contrast, cleft surgeons should focus on the finer adjustment of columella with less doubt regarding adverse effects.

Tunnel technique through three vertical buccal incisions to reduce nasolabial changes due to surgically assisted rapid palatal expansion

The aim of this technical note is to present a minimally invasive approach to the maxilla for segmental Le Fort I osteotomy in surgically assisted rapid palatal expansion (SARPE). This approach reduces the nasolabial changes that occur with the traditional circumvestibular approach.

Direct Anthropometry of Repaired Bilateral Complete Cleft Lip: A Long-Term Assessment.

Repair of bilateral complete cleft lip requires more than following a design in a textbook. The operative strategy should incorporate knowledge of anticipated nasolabial changes with growth. Direct nasolabial anthropometry was recorded in 174 children with bilateral complete cleft lip before and immediately after primary repair. Serial measurements were taken in 66 Caucasian patients between the ages of 6 months and 15 years and compared to Farkas' normal values. Data for upper philtral width were unavailable; therefore, this dimension was measured in 454 nonsyndromic Caucasian male and female subjects aged 1 year to adulthood. Rates and types of revision were also documented. Inter-medial canthal width stayed above the mean and within normal limits throughout puberty. Interalar width was initially narrowed and hovered in the high normal range throughout adolescence. Columellar height and nasal projection were constructed slightly long and paralleled normal growth. Available cutaneous philtral length was used in the primary repair; however, this dimension remained short. The philtrum was made narrow and matched normal values throughout adolescence. Normal inferior/superior philtral width ratio was 1.60 for female subjects and 1.59 for male subjects. A full median tubercle was built at primary repair but, sometimes in late childhood, necessitated secondary augmentation with a dermal graft in 31 of 174 patients (18 percent), usually performed in late childhood or adolescence. Serial anthropometry documented postoperative changes in nasolabial dimensions compared to normal growth curves. Repair of bilateral complete cleft lip requires primary correction of nasal and labial features based on their differential growth, with special attention to nasal width, philtral height and proportions, and size of the median tubercle. Therapeutic, IV.

Nasolabial changes after two different approaches for surgically assisted rapid maxillary expansion

This retrospective study evaluated the nasolabial changes in patients who underwent surgically assisted rapid maxillary expansion (SARME) using two different approaches. Nineteen patients were included in the study, divided into two groups according to the kind of surgical approach performed: group 1 (n=9), SARME performed through the standard Le Fort I circumvestibular approach followed by the alar base cinch, and group 2 (n=10), SARME performed through a subtotal vestibular approach associated to a V-shaped incision at the maxillary midline in the labial frenulum region, without alar base cinch. Measurements of width, length, and nasal projection as well as upper lip length were taken from cone beam tomographic images obtained before surgery (T1) and 6 months postoperatively (T2). Both groups presented an increase in the alar base width postoperatively (P<0.05). The approach used in group 2 resulted in smaller changes in the alar base width as measured at the superior alar curvature (P<0.05). Nasal length and projection and upper lip length were not altered by SARME. The type of surgical approach influenced nasolabial changes, but did not eliminate increase in width of the alar base.

Difference in nasolabial features between awake and asleep infants with unilateral cleft lip: Anthropometric measurements using three-dimensional stereophotogrammetry.

Cleft lip repair is performed in the supine position, tilting the head back under general anesthesia. However, postoperative results are evaluated in the upright position while patients are awake. The purpose of this study was to anthropometrically assess whether nasolabial features of infants with unilateral cleft lip are influenced by posture and anesthesia. Three-dimensional facial images in a preoperative upright position and operating supine position under general anesthesia were captured from 51 consecutive infants with unilateral cleft lip. Twenty-four indirect anthropometric measurements (11 for the nose and 13 for the lip elements) were considered on each infant. In the supine position under general anesthesia, alar surface distance was significantly shorter (p<0.001). Regarding lip measurements, medial lip height of the cleft side and philtrum height were significantly smaller (p<0.05 and p<0.05, respectively), whereas vermilion height was greater (p<0.01). In addition, the cleft width and lip width were significantly broader (p<0.001 and p<0.001, respectively) after general anesthesia. Several nasolabial alteration patterns are found after general anesthesia that are presumably attributable to cessation of nasal breathing and the action of muscle relaxation. Surgeons should take these nasolabial changes into account during preoperative planning and postoperative assessment.

Clockwise and Counterclockwise Le Fort I Movements Influence Nasolabial Morphology Differently

Le Fort I advancement impacts nasal appearance. However, no data exists assessing 3D nasal change following anterior (counterclockwise, CCW) or posterior maxillary impaction (clockwise, CW) during Le Fort I osteotomy. The purpose of this study was to analyze nasolabial changes comparing CW to CCW maxillary movements.

The Impact of Le Fort I Advancement and Widening on Nasiolabial Morphology

Le Fort I osteotomy imparts significant changes to the nasolabial region. Past studies have relied on 2-dimensional (2D) data, and have not adequately distinguished between various Le Fort I subtypes. The purpose of this study was to 3-dimensionally (3D) analyze the changes to the nose and lip following Le Fort I comparing single-piece, expanded segmental, and surgically assisted expansion (SAME). We hypothesized that the type and magnitude of movement would influence the nasolabial morphology. A retrospective cohort study was performed including Le Fort I patients grouped as: 1) non-segmental straight advancement, 2) segmental with advancement and widening, 3) surgically assisted expansion, without advancement. 108 photogrammetric datasets were analyzed, including 46 single piece, 36 segmental, and 26 SAME. The male-to-female ratio was 0.5 (mean age, 23.5). 3D photos (Canfield, Fairfield NJ) from preoperative and greater than 6-months post-procedure were analyzed. Anthropometric landmarks were placed and measured by two independent observers. Statistical analysis involved both paired and unpaired t-tests (significance = P <0.05). Mean advancement was 5.8 (± 1.8) and 5.6 (± 2.3) for the single-piece and segmental groups respectively. Significant postoperative nasal changes were observed within each intragroup analysis. Cross-group analysis demonstrated the greatest increase in alar base width (Δ3.9± 1.6), alar width (Δ4.5± 1.4), nostril width (Δ1.6± 0.7), and soft triangle angle (Δ11.1± 4), all P < .05. Nasofrontal angle decreased within the single-piece group, while philtral width increased only among the segmentals. In conclusion, dramatic nasolabial changes occur following Le Fort I osteotomy. The 3D changes are discrete and differ depending on the osteotomy group subtype. This objective understanding permits more accurate surgical planning and patient counseling.

Effects of two alar base suture techniques suture techniques on nasolabial changes after bimaxillary orthognathic surgery in Taiwanese patients with class III malocclusions

A randomized controlled trial was designed to assess the effectiveness of two alar base cinch techniques on the changes in nasolabial morphology after bimaxillary orthognathic surgery. Sixty patients requiring a Le Fort I osteotomy to correct skeletal discrepancies were selected randomly to receive either conventional or modified alar base cinching during the intraoral wound closure procedure. Conventional cinching passed through nasalis muscle and anterior nasal spine. Modified cinching also passed through dermis tissue to increase the anchorage. Postoperative hard and soft tissue changes were evaluated using cone beam computed tomography and three-dimensional stereophotogrammetry at predefined time points. Forty-eight patients with a skeletal class III malocclusion were included. In the conventional group, there was an increase of 0.31±1.31mm in nasal width and an increase of 0.97±1.60mm in columellar length. In the modified group, there was an increase of 0.81±1.87mm in the cutaneous height of the upper lip and a decrease of 0.76±1.56mm in lower prolabial width. Patients with an initial narrow nasal width, alar base width, and less vertical nostril show were more susceptible to a greater degree of change after surgery. Both alar base suture techniques are effective at controlling nasolabial form changes resulting from class III dual-jaw orthognathic surgery.

Assessment of three-dimensional nasolabial response to Le Fort I advancement

Le Fort I advancement induces soft tissue changes to the nasolabial region. The correlation of sagittal skeletal movement to soft tissue alteration has been studied using 2D methods. However, the influence of maxillary advancement has not been adequately assessed using three-dimensional means. The purpose of this study is to analyze nasolabial changes following Le Fort I advancement using 3D photometric measurements. Patient demographic information and their amount of advancement were tabulated. Pre- and postoperative 3D photographs (3D VECTRA photosystem, Canfield, Fairfield, NJ) were recorded. Nasolabial anthropometric measurements were performed using the corresponding 3D post-processing software (Mirror). Six month minimum follow-up elapsed before final evaluation. Forty-four 3D photo data sets were included. Mean maxillary advancement was 5.5 (±1.9) mm. Male/female ratio was 0.7 with a mean age of 16.7 years. Significant increases (p < 0.0001) were seen in the alar base, alar widths, nostril width, and in the soft triangle and lateral alar angles. Significant decreases (p < 0.0001) were noted in the nasofrontal angle and in nostril height. A significant (p < 0.05) increase of the nasal tip, columella and upper lip projection was seen. Philtral height showed no significant changes (p > 0.05) after maxillary advancement. No significant correlation (p > 0.05) between the degree of soft tissue changes and the amount of maxillary advancement was found. Le Fort I advancement significantly impacts the nasolabial soft tissue envelope. The 3D soft tissue changes are predictable and similar for any advancement up to 10 mm.

A Prospective Study on the Effect of Modified Alar Cinch Sutures and V-Y Closure Versus Simple Closing Sutures on Nasolabial Changes After Le Fort I Intrusion and Advancement Osteotomies

The purpose of this study was to determine whether a modified alar cinch suture and V-Y closure (mACVY) have a beneficial effect on labial form after Le Fort I intrusion and advancement osteotomies and whether they result in excessive upward nasal tip rotation. Both are possible effects compared with simple closing sutures (SCS). A prospective study was carried out on 56 patients, 31 with mACVY and 25 with SCS. Lateral cephalograms taken immediately before and 18 months after operation were used, measuring horizontal and vertical changes of the following landmarks: anterior and posterior nasal spine, A-point, incision superior, pronasale, subnasale, labiale superior, and stomion superior, as well as angular changes of sella-nasion-pronasale, and changes in upper vermilion exposure. Statistical analysis was performed on intragroup, paired t test, and intergroup differences, unpaired t test (P < .05). The horizontal and vertical changes of labiale superior were significantly larger for mACVY versus SCS, and the angle sella-nasion-pronasale increased in mACVY versus SCS. However, no significant difference was found for vertical changes of the nasal tip. Upper vermilion exposure increased with mACVY versus SCS. mACVY has a beneficial effect on labial form, and excessive upward rotation of the nasal tip is prevented.

A cephalometric appraisal of changes in the maxillofacial complex resulting from palatal suture expansion utilizing fixed appliance therapy

This retrospective study evaluated the nasolabial changes in patients who underwent surgically assisted rapid maxillary expansion (SARME) using two different approaches. Nineteen patients were included in the study, divided into two groups according to the kind of surgical approach performed: group 1 (n = 9), SARME performed through the standard Le Fort I circumvestibular approach followed by the alar base cinch, and group 2 (n = 10), SARME performed through a subtotal vestibular approach associated to a V-shaped incision at the maxillary midline in the labial frenulum region, without alar base cinch. Measurements of width, length, and nasal projection as well as upper lip length were taken from cone beam tomographic images obtained before surgery (T1) and 6 months postoperatively (T2). Both groups presented an increase in the alar base width postoperatively (P < 0.05). The approach used in group 2 resulted in smaller changes in the alar base width as measured at the superior alar curvature (P < 0.05). Nasal length and projection and upper lip length were not altered by SARME. The type of surgical approach influenced nasolabial changes, but did not eliminate increase in width of the alar base.