Three-dimensional study of facial soft tissue changes in patients with skeletal Class <b>Ⅲ</b> malocclusion before and after orthognathic surgery _Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHI Yulin ¹ , SHANG Hongtao ¹ , TIAN Lei ¹ , BAI Shizhu ² , LIU Wenjin ¹ ,  LIU Yanpu ¹

1. State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, the Forth Military Medical University, Xi’an Shaanxi, 710032, P.R.China;
2. State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Provincial Key Laboratory of Stomatology & Department of Repair, the Forth Military Medical University, Xi’an Shaanxi, 710032, P.R.China;

Corresponding author：

LIU Yanpu, Email: liuyanpu@fmmu.edu.cn

Keywords：

Orthognathic surgery; soft tissue change; three-dimensional study

DOI：

10.7507/1002-1892.201801051

Video：

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ObjectiveTo investigate the changes of facial soft tissue before and after orthognathic surgery in patients with skeletal Class Ⅲ malocclusion.MethodsBetween August 2016 and April 2017, 30 patients with skeletal Class Ⅲ malocclusion who underwent maxillary LeFort Ⅰ osteotomy and sagittal split mandible osteotomy were selected as study subjects. Among them, 11 were male and 19 were female with an average age of 22.6 years (range, 18-35 years). Full head CT scan and facial soft tissue three-dimensional image scan were performed within 2 weeks before surgery and at 6 months after surgery. A three-dimensional facial image model was established using Artec Studio 11.0 and CMF Proplan 3.0 software to analyze the facial soft tissue changes before and after surgery. The soft tissue anatomical landmarks in each area of the face were measured and compared before and after surgery.ResultsThe area of facial soft tissue change after surgery was the maxillary nose and the lower jaw area, and the two sides did not exceed the vertical boundary of the outer canthus. After surgery, the horizontal points of bilateral alar bases and bilateral cheeks changed significantly (P<0.05). The sagittal points of subnasale, pronasale, bilateral alar bases, upper lip margin significantly forwarded (P<0.05); the sagittal points of the bilateral cheilions, lower lip margin, midpoint of chin-lip groove, pogonion, and menton significantly backwarded (P<0.05). The vertical points of the upper lip margin, bilateral cheilions, lower lip margin, bilateral cheeks, and bilateral inner canthus points significantly descended (P<0.05), and the vertical point of the menton significantly elevated (P<0.05). After surgery, the nasal column was significantly shortened, the upper lip got longer and the alar base widened when compared with those before surgery (P<0.05).ConclusionThe overall change of face after double jaw surgery is shorter and fuller, and the mandible of facial soft tissue change is larger than that of maxillary, which suggests that the postoperative facial changes should be taken into account in the surgical design.

Citation： SHI Yulin, SHANG Hongtao, TIAN Lei, BAI Shizhu, LIU Wenjin, LIU Yanpu. Three-dimensional study of facial soft tissue changes in patients with skeletal Class Ⅲ malocclusion before and after orthognathic surgery . Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(5): 612-616. doi: 10.7507/1002-1892.201801051 Copy

1.	Lin J, Gu Y. Preliminary investigation of nonsurgical treatment of severe skeletal Class Ⅲ malocclusion in the permanent dentition. Angle Orthod, 2003, 73(4): 401-410.
2.	Olate S, Zaror C, Mommaerts MY. A systematic review of soft-to-hard tissue ratios in orthognathic surgery. Part Ⅳ: 3D analysis-Is there evidence? J Craniomaxillofac Surg, 2017, 45(8): 1278-1286.
3.	Mouallem G, Vernex-Boukerma Z, Longis J, et al. Efficacy of proportional condylectomy in a treatment protocol for unilateral condylar hyperplasia: A review of 73 cases. J Craniomaxillofac Surg, 2017, 45(7): 1083-1093.
4.	Becker OE, Avelar RL, Dolzan Ado N, et al. Soft and hard tissue changes in skeletal Class Ⅲ patients treated with double-jaw orthognathic surgery-maxillary advancement and mandibular setback. Int J Oral Maxillofac Surg, 2014, 43(2): 204-212.
5.	Aydemir H, Efendiyeva R, Karasu H, et al. Evaluation of long-term soft tissue changes after bimaxillary orthognathic surgery in Class Ⅲ patients. Angle Orthod, 2015, 85(4): 631-637.
6.	Lee SW, Cho J, Kim K, et al. Frontal changes in the lower face after clockwise rotation of the maxillomandibular complex without perisurgical orthodontic treatment in Angle Class Ⅰ and Skeletal Class Ⅲ women. Aesthetic Plast Surg, 2017, 41(3): 641-649.
7.	Raposo R, Peleteiro B, Paço M, et al. Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class Ⅱ malocclusion: a systematic review and meta-analysis. Int J Oral Maxillofac Surg, 2018, 47(4): 445-455.
8.	Soncul M, Bamber MA. Evaluation of facial soft tissue changes with optical surface scan after surgical correction of Class Ⅲ deformities. J Oral Maxillofac Surg, 2004, 62(11): 1331-1340.
9.	Ohba S, Kohara H, Koga T, et al. Soft tissue changes after a mandibular osteotomy for symmetric skeletal class Ⅲ malocclusion. Odontology, 2017, 105(3): 375-381.
10.	Seo SW, Jung YS, Baik HS. Three-dimensional analysis of midfacial soft tissue changes after maxillary posterior impaction and intraoral vertical ramus osteotomy for mandibular setback in Class Ⅲ patients. J Craniofac Surg, 2017, 28(7): 1789-1796.
11.	Cousley RRJ, Bainbridge M, Rossouw PE. The accuracy of maxillary positioning using digital model planning and 3D printed wafers in bimaxillary orthognathic surgery. J Orthod, 2017, 44(4): 256-267.
12.	Lee HJ, Park HS, Kyung HM, et al. Soft tissue changes and skeletal stability after modified quadrangular LeFort Ⅰ osteotomy. Int J Oral Maxillofac Surg, 2015, 44(3): 356-361.
13.	Day CJ, Robert T. Three-dimensional assessment of the facial soft tissue changes that occur postoperatively in orthognathic patients. World J Orthod, 2006,7(1): 15-26.
14.	尹晓娟, 张苗苗. 骨性安氏Ⅲ类错双颌手术后软组织的三维头影测量分析. 中国美容医学, 2012, 21(2): 277-280.
15.	Jokić D, Jokić D, Uglešić V, et al. Soft tissue changes after mandibular setback and bimaxillary surgery in Class Ⅲ patients. Angle Orthod, 2013, 83(5): 817-823.
16.	Worasakwutiphong S, Chuang YF, Chang HW, et al. Nasal changes after orthognathic surgery for patients with prognathism and Class Ⅲ malocclusion: analysis using three-dimensional photogrammetry. J Formos Med Assoc, 2015, 114(2): 112-123.

1. Lin J, Gu Y. Preliminary investigation of nonsurgical treatment of severe skeletal Class Ⅲ malocclusion in the permanent dentition. Angle Orthod, 2003, 73(4): 401-410.
2. Olate S, Zaror C, Mommaerts MY. A systematic review of soft-to-hard tissue ratios in orthognathic surgery. Part Ⅳ: 3D analysis-Is there evidence? J Craniomaxillofac Surg, 2017, 45(8): 1278-1286.
3. Mouallem G, Vernex-Boukerma Z, Longis J, et al. Efficacy of proportional condylectomy in a treatment protocol for unilateral condylar hyperplasia: A review of 73 cases. J Craniomaxillofac Surg, 2017, 45(7): 1083-1093.
4. Becker OE, Avelar RL, Dolzan Ado N, et al. Soft and hard tissue changes in skeletal Class Ⅲ patients treated with double-jaw orthognathic surgery-maxillary advancement and mandibular setback. Int J Oral Maxillofac Surg, 2014, 43(2): 204-212.
5. Aydemir H, Efendiyeva R, Karasu H, et al. Evaluation of long-term soft tissue changes after bimaxillary orthognathic surgery in Class Ⅲ patients. Angle Orthod, 2015, 85(4): 631-637.
6. Lee SW, Cho J, Kim K, et al. Frontal changes in the lower face after clockwise rotation of the maxillomandibular complex without perisurgical orthodontic treatment in Angle Class Ⅰ and Skeletal Class Ⅲ women. Aesthetic Plast Surg, 2017, 41(3): 641-649.
7. Raposo R, Peleteiro B, Paço M, et al. Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in class Ⅱ malocclusion: a systematic review and meta-analysis. Int J Oral Maxillofac Surg, 2018, 47(4): 445-455.
8. Soncul M, Bamber MA. Evaluation of facial soft tissue changes with optical surface scan after surgical correction of Class Ⅲ deformities. J Oral Maxillofac Surg, 2004, 62(11): 1331-1340.
9. Ohba S, Kohara H, Koga T, et al. Soft tissue changes after a mandibular osteotomy for symmetric skeletal class Ⅲ malocclusion. Odontology, 2017, 105(3): 375-381.
10. Seo SW, Jung YS, Baik HS. Three-dimensional analysis of midfacial soft tissue changes after maxillary posterior impaction and intraoral vertical ramus osteotomy for mandibular setback in Class Ⅲ patients. J Craniofac Surg, 2017, 28(7): 1789-1796.
11. Cousley RRJ, Bainbridge M, Rossouw PE. The accuracy of maxillary positioning using digital model planning and 3D printed wafers in bimaxillary orthognathic surgery. J Orthod, 2017, 44(4): 256-267.
12. Lee HJ, Park HS, Kyung HM, et al. Soft tissue changes and skeletal stability after modified quadrangular LeFort Ⅰ osteotomy. Int J Oral Maxillofac Surg, 2015, 44(3): 356-361.
13. Day CJ, Robert T. Three-dimensional assessment of the facial soft tissue changes that occur postoperatively in orthognathic patients. World J Orthod, 2006,7(1): 15-26.
14. 尹晓娟, 张苗苗. 骨性安氏Ⅲ类错双颌手术后软组织的三维头影测量分析. 中国美容医学, 2012, 21(2): 277-280.
15. Jokić D, Jokić D, Uglešić V, et al. Soft tissue changes after mandibular setback and bimaxillary surgery in Class Ⅲ patients. Angle Orthod, 2013, 83(5): 817-823.
16. Worasakwutiphong S, Chuang YF, Chang HW, et al. Nasal changes after orthognathic surgery for patients with prognathism and Class Ⅲ malocclusion: analysis using three-dimensional photogrammetry. J Formos Med Assoc, 2015, 114(2): 112-123.

Chinese Journal of Reparative and Reconstructive Surgery

Three-dimensional study of facial soft tissue changes in patients with skeletal Class Ⅲ malocclusion before and after orthognathic surgery

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