Midfacial soft-tissue changes after advancement of maxilla with Le Fort I osteotomy and mandibular setback surgery: comparison of conventional and high Le Fort I osteotomies by superimposition of cone-beam computed tomography volumes.

Objective: To compare the soft-tissue changes in the midfacial areas of patients who underwent conventional and high Le Fort I osteotomies with maxillary advancement, using voxel-by-voxel registration at the cranial bases, and to evaluate the influence of the level of the osteotomy cut on those soft-tissue changes.

Methods: The subjects included 42 patients (28 in group 1 and 14 in group 2) who had undergone conventional or high Le Fort I osteotomy with maxillary advancement and mandibular setback sagittal split ramus osteotomy. Using the method involving superimposition of 3-dimensional cone-beam computed tomography volumes, we evaluated the soft-tissue changes preoperatively and postoperatively. The midfacial area was measured with a 10 × 27 grid at 4.5-mm (vertical) and 5-mm (horizontal) intervals.

Results: The maxillary advancement in group 1 averaged 3.35 ± 1.06 mm at the A-point and 3.23 ± 0.98 mm at the same location in group 2. Both of the Le Fort I osteotomies induced an overall hard-to-soft tissue response in the midfacial area (P < .05).

Conclusions: In group 1, the distinctly changed soft tissue was marked near the osteotomy line and upper lip. The distribution of the changed points was within a roughly triangular area between the 2 nasolabial folds and the upper lip. In group 2, the soft-tissue changes were concentrated just below the infraorbital foramen. The distribution of the affected soft tissue after the high Le Fort I osteotomy was within the rectangular malar region between the 2 infraorbital foramens and the upper lip.