The Effect of Le Fort I Osteotomy on Nasal Tip Rotation in Dynamic Smile.

Abstract

Background: The nasal region is an essential component of facial aesthetics and is a crucial evaluation parameter in orthognathic surgery planning. Although numerous studies have investigated static changes in the nasal region at rest, dynamic changes during facial expressions such as smiling following Le Fort I surgery have not yet been evaluated.

Purpose: The aim of this study was to measure and compare the nasal tip rotation with smiling before and after orthognathic surgery.

Study design: This retrospective study examines data from maxillary advancement patients treated at Medipol Mega University Hospital (Istanbul, Türkiye) between 2018 and 2024. Patients with segmental Le Fort I surgery, maxillary asymmetry, vertical movements greater than 2.5 mm, a history of Le Fort surgery, trauma or septoplasty/rhinoplasty, craniofacial syndrome, cleft lip/palate patients, were excluded.

Predictor variables: The predictor variable was maxillary advancement magnitude (mm) and it was divided into 2 <6 mm or ≥6 mm.

Main outcome variable: The outcome variable was the angle differences between the lines drawn from the nasion to the nasal tip in resting and smiling profile photographs. The timing of resting and smiling profile photographs was reported as preoperatively (T₀) and postoperatively (T₁).

Covariates: Sex and age were considered covariates.

Analyses: Paired t-test and Wilcoxon signed-rank test were used to compare pre-operative and postoperative differences within each group. A P value <.05 was considered significant.

Results: The sample was composed of 48 subjects with a mean age of 24.23 (6.14) and 23 (47.9%) were male. The mean preoperative nasal tip rotation difference between rest and smiling was 1.57° (0.86), the mean postoperative nasal tip rotation difference was 1.30° (0.71). The nasal tip rotation difference decreased between pre-operative and postoperative periods. While the difference between the mean preoperative 1.36° (0.80) and postoperative dynamic nasal tip rotation 1.16° (0.66) in group 1 was not statistically significant (P = .2), the difference in group 2's mean preoperative 1.78° (0.88) and postoperative 1.43° (0.76) was statistically significant (P = .016).

Conclusions: In patients with more than 6-mm maxillary advancement, nasal tip rotation difference was significantly reduced during dynamic smile after orthognathic surgery.