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Le Fort I (LF1) osteotomy, a common orthognathic procedure for the maxilla aimed at achieving maxillary mobility by separating the pterygomaxillary suture, poses a risk of bad fracture that may lead to complications and inadequate mobility. Our study analyzed two- and three-dimensional computed tomography images to identify the anatomical factors associated with bad fractures due to an LF1 osteotomy. Point 'a' is where the lateral pterygomaxillary suture on the axial image aligns with the zygomatic alveolar line near the line used for an LF1 osteotomy, with the base line connecting the bilateral 'a' points.Two risk factors were identified on the pterygoid side: (i) when the distance from point 'a' to the intersection of the base line and the medial pterygoid plate was <6.0 mm; and (ii) when the distance from the piriform aperture margin to the base line was <44.78 mm. Six risk factors were identified on the maxillary side, including the distance between the most anterior and most lateral points of the internal surface of the maxillary sinus being <31.9 mm. Our analyses revealed that fractures that occur during pterygomaxillary suture separation in an LF1 osteotomy are influenced by anatomical factors of the maxilla and pterygoid process, which form the pterygomaxillary suture. [ABSTRACT FROM AUTHOR]

Le Fort I (LFI) osteotomy is commonly performed by orthognathic surgeons; however, postoperative changes in nasolabial morphology are of concern. Several factors influence such changes, but it is difficult to accurately predict the postoperative results. This study evaluated the three-dimensional (3D) morphological changes in the nasal region according to the different directions of maxillary movement during LFI osteotomy. Forty-one patients who underwent LFI osteotomies were included. All patients were divided into maxilla-up (Group U: 20 patients) and maxilla-forward (Group F: 21 patients) groups. Soft tissue morphologies were determined preoperatively and 3 or 6 months postoperatively using an optical 3D scanner. All datasets were evaluated in terms of volume changes in nine subregions and changes in linear measurements around the nasal area. Both groups exhibited increased nasal volumes after surgery in the order of the three upper, three central, and three lower subregions. The change in volume of the central nasal region tended to be greater in Group U than that in Group F. We evaluated 3D morphological changes in the nasal region according to the direction of maxillary movement during LFI osteotomy. Group U exhibited a large change in the volume of the central nasal region. [Display omitted] [ABSTRACT FROM AUTHOR]

Aim: Many different fixation methods have been proposed in the literature for the treatment of open bite. Beginning with the use of plates and screws, rigid fixation methods have become commonplace, however, open bite is a disorder prone to relapse despite rigid fixation. In our study, we aimed to eliminate the need for guided split usage during surgery and to increase postoperative stabilization in open bite patients with a new personalized plate design. Material and Method: For this purpose, a three-dimensional (3D) head model was created in the virtual environment. After the Le Fort I osteotomy on the model, the inferior segment of the maxilla was placed 1 cm forward and positioned to leave a space between the inferior and superior part of the maxilla. Different fixation methods were applied to fix the bone segments. In the first group, four plates with a thickness of 0.8 mm were fixed. In the other groups, we used three different thicknesses (0.4 mm, 0.6 mm, 0.8 mm) of the continuous plate we designed. The amount of movement and tension that occurred on the bone segments, plates, and screws were evaluated. Results: The maximum movement in the study was observed with the standard 4-plate fixation method, and the minimum movement was observed with the custom plate system with 11-screw type with a thickness of 0.8 mm. As a result, it has been found that the custom-made continuous plates provide a more rigid fixation than the standard plates. Conclusion: It may be possible to reduce the likelihood of a relapse problem by designing a plate with the appropriate thickness and form to spread the stress on the bone over a wider area. [ABSTRACT FROM AUTHOR]

While rare, complications following Le Fort I maxillary osteotomy includes hemorrhage, ischemia, infection, and vascular abnormalities. This study aimed to present an uncommon case of delayed presentation of a middle meningeal pseudoaneurysm formation after Le Fort I osteotomy. The patient initially presented with pulsatile tinnitus, and the pseudoaneurysm was subsequently treated successfully with image-guided embolization.

Abstract The purpose of this study was to report root remodeling/resorption percentages of maxillary teeth following the different maxillary osteotomies; i.e. one-piece, two-pieces, three-pieces Le Fort I, surgically assisted rapid palatal expansion (SARPE). The possibility of relationships between root remodeling and various patient- and/or treatment-related factors were further investigated. A total of 110 patients (1075 teeth) who underwent combined orthodontic and orthognathic surgery were studied retrospectively. The sample size was divided into: 30 patients in one-piece Le Fort I group, 30 patients in multi-pieces Le Fort I group, 20 patients in SARPE group and 30 patients in orthodontic group. Preoperative and 1 year postoperative cone beam computed tomography (CBCT) scans were obtained. A validated and automated method for evaluating root remodeling and resorption in three dimensions (3D) was applied. SARPE group showed the highest percentage of root remodeling. Spearman correlation coefficient revealed a positive relationship between maxillary advancement and root remodeling, with more advancement contributing to more root remodeling. On the other hand, the orthodontic group showed a negative correlation with age indicating increased root remodeling in younger patients. Based on the reported results of linear, volumetric and morphological changes of the root after 1 year, clinical recommendations were provided in the form of decision tree flowchart and tables. These recommendations can serve as a valuable resource for surgeons in estimating and managing root remodeling and resorption associated with different maxillary surgical techniques.

The purpose of this study was to report root remodeling/resorption percentages of maxillary teeth following the different maxillary osteotomies; i.e. one-piece, two-pieces, three-pieces Le Fort I, surgically assisted rapid palatal expansion (SARPE). The possibility of relationships between root remodeling and various patient- and/or treatment-related factors were further investigated. A total of 110 patients (1075 teeth) who underwent combined orthodontic and orthognathic surgery were studied retrospectively. The sample size was divided into: 30 patients in one-piece Le Fort I group, 30 patients in multi-pieces Le Fort I group, 20 patients in SARPE group and 30 patients in orthodontic group. Preoperative and 1 year postoperative cone beam computed tomography (CBCT) scans were obtained. A validated and automated method for evaluating root remodeling and resorption in three dimensions (3D) was applied. SARPE group showed the highest percentage of root remodeling. Spearman correlation coefficient revealed a positive relationship between maxillary advancement and root remodeling, with more advancement contributing to more root remodeling. On the other hand, the orthodontic group showed a negative correlation with age indicating increased root remodeling in younger patients. Based on the reported results of linear, volumetric and morphological changes of the root after 1 year, clinical recommendations were provided in the form of decision tree flowchart and tables. These recommendations can serve as a valuable resource for surgeons in estimating and managing root remodeling and resorption associated with different maxillary surgical techniques. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate maxillary bone healing and computed tomography (CT) values after Le Fort I osteotomy with sagittal split ramus osteotomy in patients with class II and III malocclusion. Four absorbable plates and screws were used to fix the maxillary segments in all patients. For 112 sides (58 patients), the bone defect areas at the anterior and posterior sites between the maxillary segments were measured using 3-dimensional CT views reconstructed over a constant CT value at 1 week and 1 year postoperatively. Subsequently, CT values at the upper, middle, and lower sites around the osteotomy line in the medial, middle, and lateral regions were measured. The bone defect area after 1 year increased at the anterior site in class III and at both the anterior and posterior sites in class II (P < 0.05). This study suggests that the increase in bone defect area was affected by lower CT values at the middle site of the middle and lateral regions in class II, and that bony defects between fragments in the maxilla could partially remain in both classes II and III within 1 year after Le Fort I osteotomy. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the incidence of preoperative and postoperative complications in patients undergoing orthognathic surgery. Methods: The clinical records and radiographs of 112 patients who undergone orthognathic surgery between 2014 and 2021 were retrospectively analyzed. Patients’ demographics, follow-up period, type of malocclusion and operation were recorded. All surgical complications were evaluated into two groups as intraoperative or postoperative complications. Results: The mean age of 112 patients (69 female, 43 male) was 24.4 ± 5.5 (ranging from 16 to 47). The most frequent intraoperative complication was the bad split (5 cases, 4.5%), followed by severe hemorrhage due to rupture of facial artery (1 case, 0.9%), dissection of inferior alveolar nerve (1 case, 0.9%), and dental damage (1 case, 0.9%). The most common postoperative complication was the neurosensorial deficit (29 cases, 25.9%), followed by infection (6 cases, 5.4%), extraoral scar formation (5 cases, 4.5%), fracture of fixation material (2 cases, 1.8%), maxillary non-union (2 cases, 1.8%), postoperative nasal hemorrhage (1 case, 0.9%), and failure of fixation material (1 case, 0.9%). There were no fatal complications. Conclusion: Although the wide range of complications related to orthognathic surgery is reported both in our study and the literature, the frequency of these appears to be uncommon. However, in order to manage the complications of the operation properly, through knowledge and experience are essential. Keywords: Complication, Le Fort I osteotomy, Orthognathic surgery, Sagittal split osteotomy Ortognatik Cerrahi Operasyonu Sırasında ve Sonrasında Gelişen Komplikasyonların Değerlendirilmesi ÖZ Amaç: Bu çalışmanın amacı, ortognatik cerrahi uygulanan hastalarda operasyon sırasında ve sonrasında ortaya çıkan komplikasyonların insidansını değerlendirmektir. Yöntemler: 2014-2021 yılları arasında ortognatik cerrahi operasyonu uygulanan 112 hastanın klinik kayıtları ve radyografileri retrospektif olarak incelendi. Hastaların demografik verileri, takip süresi, maloklüzyon ve operasyon tipi kaydedildi. Tüm cerrahi komplikasyonlar, operasyon sırasında ve sonrasında olmak üzere iki grupta incelenerek değerlendirildi. Bulgular: 112 hastanın (69 kadın, 43 erkek) ortalama yaşı 24,4 ± 5,5 (16-47 arasında) idi. Operasyon sırasında en sık görülen komplikasyon kötü kırık oluşumuydu (5 vaka, %4,5) ve bunu fasiyal arter rüptürüne bağlı olarak görülen şiddetli kanama (1 vaka, %0,9), inferior alveolar sinir diseksiyonu (1 vaka, %0,9) ve dental hasar (1 vaka, %0,9) takip etti. Operasyon sonrasında en sık karşılaşılan komplikasyon ise nörosensoriyel bozukluktu (29 vaka, %25,9) ve bunu enfeksiyon gelişimi (6 vaka, %5,4), ekstraoral skar oluşumu (5 vaka, %4,5), fiksasyon materyalinin fraktürü (2 vaka, %1,8), maksillada osteotomi hattının kemikleşmemesi (2 vaka, %1,8), postoperatif nazal hemoraji (1 vaka, %0,9) ve fiksasyon materyalinin kaybı (1 vaka, %0,9) izledi. Hiçbir hastada hayatı tehdit edici bir komplikasyon ile karşılaşılmadı. Sonuç: Bu çalışmada ve literatürde ortognatik cerrahi ile ilişkili olarak çeşitli komplikasyonlar bildirilse de, bu komplikasyonların görülme sıklığı azdır. Ancak, operasyonda ortaya çıkabilecek komplikasyonların uygun bir şekilde yönetilebilmesi için yeterli bilgi ve deneyime sahip olmak büyük önem taşımaktadır. Anahtar Kelimeler : Le Fort I osteotomisi, Komplikasyon, Ortognatik cerrahi, Sagittal split osteotomy

Purpose: to describe a surgical treatment of a case in vertical posterior maxillary alveolar ridge excess and to perform a literature review of various surgical options. Methods: we described a patient treated with a Le Fort I and a posterior maxillary segmental osteotomy (PMSO) for prosthodontic rehabilitation. A literature review on surgical treatments in posterior maxillary alveolar ridge excess is performed on Scopus, Embase, Pubmed and Cochrane with specific keywords. Results: the case described is finally rehabilitated with implants in the mandible according to a correct Spee curve and occlusal plane. 49 articles describe surgical procedures of vertical posterior maxillary alveolar ridge excess. Only two reviews are described. Discussion: literature has paid little attention to different combined orthognathic surgery procedures in prosthodontic rehabilitation of posterior maxilla. The orthognathic option is sometimes considered aggressive and difficult but with proper knowledge of the technique and surgical experience, correct and stable modification of inter arch space can be reached with predictability. Conclusion: correct surgical and dental prosthetic planning are important to achieve a stable functional and aesthetic solution for patients.

To evaluate the accuracy of maxillary repositioning in two-jaw surgery using computer-aided surgical simulation (CASS) and computer-aided design/manufacturing (CAD/CAM) splints by using a highly accurate observer-independent method. A retrospective evaluation was conducted of 30 consecutive adults who underwent Le Fort I osteotomy by a single surgeon. Surgical planning and fabrication of occlusal splints were performed using custom-developed CASS software. Preoperative images with landmarks were superimposed on postoperative images to evaluate discrepancies between the planned and actual position of the maxilla following surgery. Translational and rotational differences were expressed as the root mean square deviation (RMSD). The number of cases that exceeded the clinically acceptable limits (2 mm for the translational difference at the centroid, 4° for the rotational difference, and 1 mm for the mediolateral difference at the dental midline) were also evaluated. Postoperative anteroposterior translation and pitch values were significantly different to and negatively correlated with the planned values, respectively. The largest translational RMSDs at the centroid and the dental midline were 1.04 mm and 1.03 mm, respectively, in the anteroposterior direction. The largest rotational RMSD was 1.86° in pitch. The percentage of discrepancies exceeding the clinically acceptable limit was 3.3% for the centroid, 3.3% for rotation, 20.0% for the midline, and 26.7% for any one criterion. While maxillary repositioning using CASS and CAD/CAM splints was accurate on a population level, there remains potential for clinically significant errors to occur on an individual level, particularly in controlling the dental midline position and occlusal plane angle. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the effect of orthognathic surgery on taste sensation. Materials and methods: Thirty-five patients scheduled to undergo Le Fort I osteotomy (LFIO), sagittal split ramus osteotomy (SSRO), and bimaxillary surgery (BMS) were evaluated by administering localized and whole-mouth taste tests preoperatively and postoperatively at months 1, 3, and 6. The patients were asked to identify the quality of four basic tastes applied to six locations on the palate and tongue and to rate the taste intensities they perceived. Taste recognition thresholds and taste intesity scores were evaluted according to operation groups and follow-ups. Results: There were significant decreases in the quinine HCl recognition thresholds at the postoperative follow-ups compared to the preoperative in LFIO patients (p = 0.043). There were significant decreases in sucrose taste intensity scores in the right posterolateral part of the tongue at months 3 and 6 compared to preoperative in SSRO patients (p = 0.046), and significant increases in quinine HCL taste intensity scores in the right and left anterior parts of the tongue at month 6 compared to preoperative in LFIO patients (p < 0.05). Conclusion: Taste perception is affected due to potential damage to the chemosensory nerves during orthognathic surgical procedures. Generally, non-significant alterations have been observed in taste perception after orthognathic surgery, except for significant alterations in bitter and sweet taste perceptions. Clinical relevance: Maxillofacial surgeons should be aware of taste perception change after orthognathic surgery procedures and patients should be informed accordingly. The trial registration number (TRN): NCT06103422/Date of registration: 10.17.2023 (retrospectively registered). [ABSTRACT FROM AUTHOR]

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Introduction: Maxillomandibular advancement (MMA) remains an effective procedure for the management of obstructive sleep apnea (OSA). Maxillary advancement may lead to anatomical changes that impair paranasal sinus drainage, leading to chronic sinus inflammation. The aim of this study was to describe the clinical features and outcomes of patients suffering from chronic rhinosinusitis (CRS) following MMA. Methods: This is a retrospective case series study. Our study included subjects diagnosed with CRS following MMA from January 1992 to October 2018 at Stanford Hospital. We screened 730 patients undergoing MMA and identified a total of 57 with CRS after MMA. A descriptive analysis was performed using clinical data including patient demographics, comorbidities, prior surgical history, physical exam manifestations, CT findings, and quality of life outcomes (SNOT-22). Results: Out of 730 patients undergoing MMA, 57(7.8%) were found to have CRS after orthognathic surgery. Presenting symptoms included facial pain (92.5%), nasal drainage (75%), nasal obstruction (67.5%), and hyposmia (20%). Endoscopic examination revealed recirculation (30.5%), purulent discharge (27.7%), polypoid changes (22.2%), and scarring (13.8%). Preoperative CT prior to undergoing endoscopic sinus surgery (ESS) demonstrated mucosal thickening in maxillary (64.2%), anterior ethmoid (39.2%), frontal (14.2%), posterior ethmoid (10.7%), sphenoid sinus (14.2%), and ostiomeatal complex (55.3%). Average Lund-Mackay score was 5.5(±3.8). Additional CT findings included secondary ostium in the inferior meatus (42.8%). Forty patients (70.1%) underwent ESS at a mean of 4.6 years after MMA. Patients undergoing ESS experienced significant improvement in SNOT-22 scores at 12-months post-surgery (P =.018). Conclusion: Patients undergoing maxillary advancement surgery are at risk of developing CRS postoperatively and should be advised of the risk of CRS associated with this procedure. Surgical treatment can be an option for medically refractory CRS related to MMA surgery. [ABSTRACT FROM AUTHOR]

Purpose: Variations in nasal wall anatomy are crucial in patients with dentofacial deformities undergoing Le Fort I osteotomy. These structural variations heighten the potential for complications during surgical procedures. Hence, the study focused on evaluating the differences in the lateral nasal wall anatomy across different skeletal Classes. Methods: This study evaluated 86 patients aged 18–43 years with different skeletal Classes. In the axial images acquired from coronal sections, two angulations and the linear distances of the lateral nasal wall were measured in Class I, II, and III patients. The measurement between the piriform opening and the most anterior point of the greater palatine foramen was evaluated in three parts regarding the osteotomy line. Differences between the skeletal patterns were analyzed using an independent sample t-test and Mann–Whitney U test with a significance level of 0.05. The intra-class correlation coefficient was calculated for inter-observer and intra-observer agreement. Results: There was a statistically significant difference between Class I and Class II subjects regarding the anterior lateral nasal wall (p = 0.011) and anterior nasal thickness (a) (0.004). There was a significant difference between Class I and Class III patients regarding anterior nasal thickness (a) (p < 0.001) and total lateral nasal wall length (p < 0.001). Conclusion: For instance, the measurements of Class III and Class II patients were relatively different from those of the Class I patients. Therefore, preoperative Cone-Beam Computed Tomographic analysis should be performed for each patient prior to Le Fort I osteotomy to ensure that the procedure is performed safely. [ABSTRACT FROM AUTHOR]

Objective: Unilateral temporomandibular joint ankylosis with jaw deformity (UTMJAJD) may require simultaneous total joint prosthesis (TJP) reconstruction, sagittal split ramus (SSRO), and Le Fort I osteotomies. The purpose of this study was to evaluate outcomes in patients treated with these procedures. Methods: Patients diagnosed UTMJAJD between 2016 and 2018 were selected for the study. Mandible-first procedure was performed after ankylosis release with TJP on the ankylosed side and SSRO on the contralateral side. Le Fort I osteotomy with and without genioplasty was lastly performed. Maximal incisor opening (MIO), facial symmetry, and jaw and condyle stability were compared before, after operation, and during follow-ups. Results: Seven patients were included in the study. Their average chin deviation was 9.5 ± 4.2 mm, and maxillary cant was 5.1 ± 3.0°. After operation, jaw deformity significantly improved, with chin deviation corrected 7.6 ± 4.1 mm (p = 0.015) and advanced 5.9 ± 2.5 mm (p = 0.006). After an average follow-up of 26.6 ± 17.1 months, MIO significantly increased from 11.4 ± 9.3 to 35.7 ± 2.6 mm (p = 0.000). The occlusion was stable with no significant positional or rotational changes of the jaw (p > 0.05). There was no obvious condylar resorption during follow-ups. Conclusion: Simultaneous TJP reconstruction, SSRO, and Le Fort I osteotomy are reliable and effective methods for the treatment of UTMJAJD. [ABSTRACT FROM AUTHOR]

Orthognathic surgery may induce hemorrhage resulting from nasal mucosal injury or from maxillary osteotomy sites, and if severe, the hemorrhage may cause airway obstruction. The patient in this case report was a 27-year-old woman who underwent Le Fort I and bilateral sagittal split osteotomies under general anesthesia. There were no abnormal intraoperative vital signs. However, immediately after the patient was returned to the ward, significant bleeding that required frequent suctioning was observed in the oral cavity. As the bleeding persisted, the surgeon attempted to insert epinephrine-soaked gauze and polyvinyl acetal sponges into both nasal cavities, but hemostasis was difficult to obtain. To achieve hemostasis by compression/closure at the choana and maintain nasal patency, we inserted a modified cuffed endotracheal tube to serve as a transnasal airway and a choanal hemostatic balloon. This method resulted in hemostasis. The volume of blood loss after returning to the ward was approximately 420 mL. The transnasal airway and choanal balloon was useful for airway management and the prevention of intranasal bleeding into the lower pharyngeal regions. Furthermore, the method was simple and minimally invasive, suggesting its clinical usefulness in similar situations. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the correlation between temporomandibular joint (TMJ) disc position and skeletal stability and identify the cephalometric measurements associated with relapse after bimaxillary surgery. Methods: The participants were 62 women with jaw deformities (124 joints) who underwent bimaxillary surgery. The TMJ disc position was classified into four types (anterior disc displacement (ADD), anterior, fully covered, and posterior) using magnetic resonance imaging, and cephalometric analysis was performed preoperatively and 1 week and 1 year postoperatively. The differences between pre- and 1-week postoperative values (T1) and 1-week and 1-year postoperative value (T2) were calculated for all cephalometric measurements. Moreover, the relationship between skeletal stability using cephalometric measurements, skeletal class, and TMJ disc position was analyzed. Results: The participants included 28 patients in class II and 34 in class III. There was a significant difference in T2 in SNB between class II mandibular advancement cases and class III mandibular setback cases (P = 0.0001). In T2, in ramus inclination, there was a significant difference between the ADD and posterior types (P = 0.0371). Stepwise regression analysis revealed that T2 was significantly correlated with T1 for all measurements. However, the TMJ classification was not applied to all measurements. Conclusion: This study suggested that TMJ disc position, including ADD, could not affect skeletal stability, including the maxilla and distal segment after bimaxillary osteotomy, and short-term relapse could be related to the movement amount or angle change by surgery for all measurements. [ABSTRACT FROM AUTHOR]

Introduction Lips play a fundamental role in facial attractiveness and in decisions pertaining to orthognathic surgery. Objective To assess the upper lip changes following Le Fort I osteotomy for maxillary advancement and/or impaction. Methods In the present retrospective non-randomized clinical trial, we evaluated 3 groups of patients who underwent Le Fort I osteotomy of the maxilla. Group 1 (n = 35) underwent maxillary advancement, group 2 (n = 14), maxillary impaction, and group 3 (n = 11) was submitted to both maxillary advancement and impaction. The lip thickness of all patients was measured preoperatively, and the participants in each group were categorized into two subgroups: thin (< 12 mm) and thick (> 12 mm) lip. The primary (before orthognathic surgery) and final (after orthodontic bracket removal) lateral cephalograms of the patients were analyzed using the Dolphin software. Comparisons were made using the paired t -test and linear regression in the IBM SPSS Statistics for Windows software. Results The length of the upper lip increased by 1 mm (p = 0.012) on average following maxillary advancement, and it decreased by 0.43 mm (p = 0.24) on average following maxillary impaction. In the maxillary advancement group, the change in angulation of the incisors predicted the incisal display (p = 0.03). In the maxillary impaction group, skeletal changes in the vertical dimension predicted changes in upper lip length (p = 0.033). Conclusions Le Fort I osteotomy for maxillary advancement significantly increases the length of the upper lip. The assessment of lip thickness prior to surgery can help predict the postoperative results. Changing the angulation of the incisors can predict the incisal display. In maxillary impaction, skeletal changes in the vertical dimension can predict the changes in the length of the upper lip. [ABSTRACT FROM AUTHOR]

Patients with cleft lip and palate often shows vertical and horizontal malocclusion because of maxillary hypoplasia and alveolar collapse. They need to repair it by orthognathic treatment in adults. It is essential to make a corrective and certain surgery to get satisfied occlusion. We performed left segmental osteotomy and secondary bone grafting simultaneously to a man with left cleft lip and palate presenting maxillary hypoplasia, left alveolar cleft and vertical displacement of major and minor segments. 11 months after left segmental osteotomy and secondary bone grafting, we performed Le Fort I osteotomy and bilateral sagittal splitting ramus osteotomy. First, we could improve the vertical displacement of major and minor segments by segmental osteotomy and align the dental arch. Moreover, the forward movement of segmental osteotomy reduces the alveolar cleft space. Owing to it, we could perform secondary bone grafting by minimum autologous cancellous bone from ilium. At the second surgery, we could perform Le Fort I osteotomy easily and simply because the maxilla had been made of a mass by first operation, that is loss of alveolar cleft. It should be an effective approach to perform segmental osteotomy and secondary bone grafting simultaneously as a first stage for orthognathic treatment for unilateral cleft lip and palate patients with vertical alveolar collapse and cleft. [ABSTRACT FROM AUTHOR]

This study reported two cases of acute life-threatening hemorrhage after Le Fort I osteotomy. In both cases, computed tomography and angiography revealed damage to the descending palatine artery, which was successfully treated by angiographic embolization. Although massive hemorrhage after Le Fort I osteotomy is rare, acute hemorrhage from the postoperative area may occur. Angiographic embolization is useful in cases of such hemorrhage from the posterior nasal cavity where endoscopic hemostasis is not possible. [ABSTRACT FROM AUTHOR]

The aim of this prospective cohort study was to compare changes in nasal cavity and function between Le Fort I with and without horseshoe osteotomy after superior repositioning of the maxilla. The patients were divided into 2 groups, a Le Fort I alone (LF alone) group and a combination Le Fort I and horseshoe osteotomy (HS) group. The nasal cavity volume was measured using 3-dimensional computed tomographic images, and nasal resistance was assessed by anterior active mask rhinomanometry. The HS group consisted of 17 patients, and the LF alone group consisted of 15 patients. The magnitude of change in nasal cavity volume was significantly smaller in the HS group than in the LF alone group (p < 0.001), even though the mean amount of superior maxillary movement was considerably larger in the HS group than in the LF alone group (p < 0.001). Mean nasal resistance was significantly smaller postoperatively than preoperatively in the HS group (p < 0.05). Furthermore, the change in nasal resistance was smaller in the HS group than in the LF alone group (p < 0.001). Within the limitations of this study, it seems that horseshoe osteotomy is useful for maintaining the nasal cavity and function after superior repositioning of the maxilla. [ABSTRACT FROM AUTHOR]

Objective: Le Fort I osteotomy (LF-IO) is widely used for the correction of dentofacial deformities, which may cause changes in the postoperative nasal septum (NS). The objective of this study was to evaluate the effects of LF-IO on the NS deviation and to determine whether the NS was affected by differences in the direction of maxilla movement. Materials and Methods: A retrospective study including 57 patients who underwent LF-IO and received cone beam computed tomography (CBCT) preoperatively and 6–12 months postoperative evaluation was performed. The NS angle of each patient was measured both pre- and postoperatively in the two coronal sections (nasion and ostium levels). The patients were divided into five paired groups and calculated. Group 1 to 4 were divided depending on the differences in the direction of maxilla movement (Group 1. Impaction ≥ 5 mm vs. Impaction < 5 mm; Group 2. Anterior movement vs. Non-anterior movement; Group 3. Impaction symmetry vs. Impaction asymmetry; and Group 4. Impaction vs. Inferior repositioning). Group 5 was divided as One-piece osteotomy vs. Multi-segmental osteotomy. Results: The mean NS angles at both nasion and ostium levels of all patients were significant increased after LF-IO. However, there were no statistical significant differences of the five paired groups. Conclusions: LF-IO osteotomy influenced increasing of the NS deviation at both the nasion and ostium levels. However, differences in the direction of the maxilla movement and maxilla segmentation showed no statistically significant changes. [ABSTRACT FROM AUTHOR]

This case report presents a rare but significant complication of abducens nerve palsy following Maxillary Le Fort I osteotomy. The patient, who underwent the procedure for trans palatal distraction indication, experienced left-sided abducens nerve palsy, characterized by the inability to abduct the ipsilateral eye. Undesired fracture patterns can extend to neighbouring structures. The report discusses the management strategies employed and the outcome of this specific complication. By sharing this case, it aims to increase awareness of the potential risks associated with Maxillary Le Fort I osteotomy and provide insights for optimizing surgical outcomes and improving patient safety.

Background: Traditionally bur has been used to carry out osteotomy. In a developing country like India, the cost of surgical treatment is the important factor in determining treatment plan. Although the use of bur is cost-effective and efficient, with the advent of newer technology, it is getting replaced with a saw. Aim: To evaluate and compare the use of reciprocating saw and bur in Le Fort I Osteotomy for superior repositioning of the maxilla. Materials and Methods: Patients referred from the Department of Orthodontics for the surgical correction of vertical maxillary excess (VME). They were divided into two groups. In group I, osteotomy was performed with Synthes Reciprocating Saw and in group II, bur was used. The parameters recorded in both the groups were time required for the completion of down-fracture, precision of the osteotomy cut (margins of the cut), and ease of superior repositioning. Data was collected from both the groups for comparison. Results: A total of 14 patients with VME were included in the study. They were divided into two groups. Seven study participants were allotted to each group. In group I, Synthes Reciprocating Saw was used while in group II, a bur was used to carry out the osteotomy cut. In group I, the average time required to complete the down-fracture of the maxilla was 3.5–4 min while in group II it was more than 8 min. The margins of the osteotomy cut were smooth and regular and there was bone-to-bone contact during superior repositioning in Group I. Conclusion: The combination of the use of a saw for inferior osteotomy and a bur for the superior cut would be more beneficial in the superior repositioning of the maxilla.

Introduction Lips play a fundamental role in facial attractiveness and in decisions pertaining to orthognathic surgery.

Mandibular deformities negatively affect the daily activities of the patients and may cause temporomandibular disorders (TMD). Bilateral sagittal split ramus osteotomy (BSSRO) and Le Fort I osteotomy are effective treatments to correct the mandibular deformities. The aim of this study was to investigate and compare the effects of the BSSRO with or without Le Fort I on the stress distributions of the temporomandibular joints (TMJs) of the patients with mandibular deformities under centric occlusion based on finite element (FE) method. Preoperative and postoperative cone-beam computed tomography (CBCT) images of twenty-four patients diagnosed with mandibular prognathism, including ten patients with BSSRO and another 14 patients with bimaxillary osteotomy (BSSRO with Le Fort I), were used to construct maxillofacial models. Ten asymptomatic individuals were also performed CBCT scanning and defined as the control group. In addition, the muscle forces and boundary conditions corresponding to centric occlusions were applied on each model. For the preoperative groups with both the BSSRO and bimaxillary osteotomies, the average peak contact stresses of the TMJs were both greater than those of the control group. After the surgeries, the contact stresses of the discs and temporal bones of both groups considerably decreased. However, the contact stresses on the condyles slightly increased after BSSRO but decreased after bimaxillary osteotomy. The TMJs of the patients with maxillofacial deformities suffered abnormal tensile and compressive stresses compared with the asymptomatic subjects under centric occlusion. Both of the BSSRO and bimaxillary osteotomy could improve the risk stress distributions of the TMJs. [ABSTRACT FROM AUTHOR]

Bimaxillary orthognathic surgery is widely used for the correction of dentoskeletal deformities. Surgery sequencing (maxilla or mandible first) remains debated, and guidelines and consensus are lacking. This scoping review summarizes the state of the art and compares the advantages and disadvantages of both approaches. The review was conducted following PRISMA-ScR guidelines. Three electronic databases (PubMed, Scopus, Web of Science) were searched using the PICO protocol and key words in orthognathic surgical sequencing. Four reviewers screened the records independently, and disagreement was resolved by consensus. A total of 23 records met the inclusion criteria. The advantages and disadvantages of the two approaches were compared and assessed for accuracy of reporting. Within the limitations of the present study, available evidence for the intrinsic advantages and the accuracy of the mandible-first sequence supports the choice of this approach in most cases. Nevertheless, each clinical case needs to be evaluated individually, as no dogmatic recommendations can be given for sequencing in bimaxillary orthognathic surgery. [ABSTRACT FROM AUTHOR]

Traditionally bur has been used to carry out osteotomy. In a developing country like India, the cost of surgical treatment is the important factor in determining treatment plan. Although the use of bur is cost-effective and efficient, with the advent of newer technology, it is getting replaced with a saw. To evaluate and compare the use of reciprocating saw and bur in Le Fort I Osteotomy for superior repositioning of the maxilla. Patients referred from the Department of Orthodontics for the surgical correction of vertical maxillary excess (VME). They were divided into two groups. In group I, osteotomy was performed with Synthes Reciprocating Saw and in group II, bur was used. The parameters recorded in both the groups were time required for the completion of down-fracture, precision of the osteotomy cut (margins of the cut), and ease of superior repositioning. Data was collected from both the groups for comparison. A total of 14 patients with VME were included in the study. They were divided into two groups. Seven study participants were allotted to each group. In group I, Synthes Reciprocating Saw was used while in group II, a bur was used to carry out the osteotomy cut. In group I, the average time required to complete the down-fracture of the maxilla was 3.5–4 min while in group II it was more than 8 min. The margins of the osteotomy cut were smooth and regular and there was bone-to-bone contact during superior repositioning in Group I. The combination of the use of a saw for inferior osteotomy and a bur for the superior cut would be more beneficial in the superior repositioning of the maxilla. [ABSTRACT FROM AUTHOR]

(1) Background: In orthognathic surgery, segmental Le Fort I osteotomies are a valuable method to correct maxillary deformities or transversal discrepancies. However, these procedures are technically challenging, and osteosynthesis can be prone to error. (2) Methods: In this retrospective, monocentric cohort study, patients were enrolled who underwent a virtually planned segmental maxillary osteotomy during their combined treatment. Positioning and osteosynthesis were achieved by either a 3D-printed splint and conventional miniplates or patient-specific implants (PSI). The preoperative CT data, virtual planning data, and postoperative CBCT data were segmented. The deviation of all the segments from the desired virtually planned position was measured using the analysis function of IPS CaseDesigner. (3) Results: 28 Patients in the PSI Group and 22 in the conventional groups were included. The PSI group showed significantly lower deviation from the planned position anteroposteriorly (−0.63 ± 1.62 mm vs. −1.3 ± 2.54 mm) and craniocaudally (−1.39 ± 1.59 mm vs. −2.7 ± 3.1 mm). For rotational deviations, the pitch (0.64 ± 2.59° vs. 2.91 ± 4.08°), as well as the inward rotation of the lateral segments, was positively influenced by PSI. (4). Conclusions: The presented data show that patient-specific osteosynthesis significantly reduces deviations from the preoperative plan in virtually planned cases. Transversal expansions and vertical positioning can be addressed better. [ABSTRACT FROM AUTHOR]

Copyright of China Journal of Oral & Maxillofacial Surgery is the property of Shanghai Jiao Tong University, College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The purpose of this systematic review was to evaluate the outcome of dental implant treatment in fully edentulous patients who underwent Le Fort I osteotomy as a preprosthetic surgical technique. Materials and Methods: A search was conducted of the PubMed (MEDLINE), EMBASE, Scopus, and Cochrane databases to identify records published from 1995 to 2017 dealing with Le Fort I osteotomy procedures for implant placement purposes. The primary outcomes of interest were the survival and success rates. The secondary outcomes consisted of the analysis of intrasurgical and postsurgical complications and the surgical and prosthetic loading protocols. Results: Overall, 20 articles were selected for data analysis. A total of 483 patients accounting for 3,596 implants were analyzed. The cumulative survival rate was 90.22% ± 0.8% at 10 years (mean: 59.20 ± 32.31 months). The cumulative success rate was 89.07% ± 1.3% at 10 years (mean: 62.82 ± 25 months). Higher survival rates were found for implants with a rough surface (P < .001) and for implants loaded with a delayed protocol (P < .001). The fracture of the palatine bone during the downfracture procedure was the main intrasurgical drawback, while sinus pathology and graft resorption were commonly observed during the postoperative healing. Surgical and prosthetic loading protocols were heterogenous. Conclusion: Based on this review, Le Fort I osteotomy might be considered a viable technique to recreate favorable conditions for implant-supported rehabilitations. Caution has to be taken when using machined implants, particularly in the case of a simultaneous approach. [ABSTRACT FROM AUTHOR]

Objectives: The design and fabrication of three-dimensional (3D)-printed patient-specific implants (PSIs) for orthognathic surgery are customarily outsourced to commercial companies. We propose a protocol of designing PSIs and surgical guides by orthognathic surgeons-in-charge instead for wafer-less Le Fort I osteotomy. The aim of this prospective study was to evaluate the accuracy and post-operative complications of PSIs that are designed in-house for Le Fort I osteotomy. Materials and methods: The post-operative cone beam computer tomography (CBCT) model of the maxilla was superimposed to the virtual surgical planning to compare the discrepancies of pre-determined landmarks, lines, and principal axes between the two models. Twenty-five patients (12 males, 13 females) were included. Results: The median linear deviations of the post-operative maxilla of the x, y, and z axes were 0.74 mm, 0.75 mm, and 0.72 mm, respectively. The deviations in the principal axes for pitch, yaw, and roll were 1.40°, 0.90°, and 0.60°, respectively. There were no post-operative complications related to the PSIs in the follow-up period. Conclusions: The 3D-printed PSIs designed in-house for wafer-less Le Fort I osteotomy are accurate and safe. Clinical relevance: Its clinical outcomes and accuracy are comparable to commercial PSIs for orthognathic surgery. Trial registration: Clinical trial registration number: HKUCTR-2113. Date of registration: 29 July 2016. [ABSTRACT FROM AUTHOR]

The use of virtual surgical planning and patient-specific saw and drill guides combined with customized osteosynthesis is becoming a gold standard in orthognathic surgery. The aim of this study is to report preliminary results of the use of virtual surgical planning and the wafer-free PSI technique in cleft patients. Patient-specific saw and drill guides combined with milled patient-specific 3D titanium alloy implants were used in reposition and fixation in Le Fort I osteotomy of 12 cleft patients. Surgical information was retrieved from hospital records. Pre- and post-operative lateral cephalograms were analyzed. In 10 of 12 cases, the implants fitted as planned to predesigned drill holes and bone contours with high precision. In one patient, the mobilization of the maxilla was too demanding for virtually planned advancement, and the implants could not be used. In another patient, PSI fitting was impaired due to an insufficient mobilization of maxilla and tension on PSI fixation with screws. After the surgery, the mean advancement of the anterior maxilla (point A) of all patients was 5.8 mm horizontally (range 2.7–10.1) and −3.1 mm vertically (range −9.2 to 3.4). Skeletal relationships of the maxilla and mandible could be corrected successfully in all patients except for the one whose PSI could not be used. Virtual surgical planning combined with PSI is a possible useful clinical adjunct for the correction of maxillary hypoplasia in cleft patients. Large maxillary advancements and scarring may be cause problems for desired advancement and for the use of implants. [ABSTRACT FROM AUTHOR]

This study was conducted to evaluate the postsurgical stability of Le Fort I osteotomy using zygomatic buttress internal fixation alone with no piriform aperture internal fixation. Patients with maxillary retrognathia and mandibular prognathism underwent the Le Fort I osteotomy with a bilateral sagittal split ramus osteotomy. In group I, fixation was accomplished using titanium plate and screws placed at the piriform aperture and the zygomatic buttress (4 plates). In group II, fixation was accomplished using titanium plate and screws placed at the zygomatic buttress (2 plates). Lateral cephalometric radiographs were taken preoperatively (T1), immediately after surgery (T2), and at 6 months to 1 year (T3) to evaluate skeletal movement. In total, 32 patients were included in this study. None of the patients had wound infection, dehiscence, bone fragment instability, and long-term malocclusion. Regarding point A and the posterior nasal spine (PNS), vertical and horizontal relapse in groups I and II did not differ significantly. In most hospitals, the maxilla was fixed using four plates (piriform aperture and zygomatic buttress); however, within the limitations of the study, the choice of the number of plates for osteosynthesis following Le Fort I osteotomy and repositioning of the maxilla can be left to the discretion of the surgeon without putting the patients at risk for increased relapse by careful intraoperative management. [ABSTRACT FROM AUTHOR]

Copyright of China Journal of Oral & Maxillofacial Surgery is the property of Shanghai Jiao Tong University, College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this study is to evaluate Le Fort I Osteotomy and zygomatic implantation without any graft placement for management of a cleft lip and palate patient. This case report describes oral rehabilitation of a 33-year-old patient with bilateral cleft lip-palate and oronasal fistula and atrophic pre-maxilla. As treatment, the patient received simultaneous Le Fort I osteotomy, palatoplasty and two zygomatic implant insertions. The prosthetic superstructure included zygomatic implant-supported removable hybrid prosthesis on bar locator and metal-ceramic fixed bridges in the posterior region. As conclusion, this protocol can be promising for management of patients with cleft lip-palate and malocclusion. [ABSTRACT FROM AUTHOR]

Objectives: Dynamic analysis of chewing impact on the stability of rigid fixation techniques following Le Fort I osteotomy has not been investigated in the previous literature. The aim of the present study was to evaluate segmental displacement and von Mises (VM) stress values on the fixation devices following different amounts of Le Fort I advancements under dynamic loading conditions., Materials and Methods: The 3D finite element models simulating 3, 5 and 8 mm advancement of maxilla at the Le Fort I level were generated using CBCT scan data. The models included two anterior L plates and two posterior I plates fixations bilaterally. Dynamic finite element analysis was performed to evaluate their biomechanical behavior against chewing cornflakes bio. Von Mises stresses and displacement values on three points were calculated., Results: Calculations were made in a time of 38, 40 and 40.5 ms for 3, 5 and 8 mm advancement models, respectively. As the advancement increased, stress values on the plates and displacement values in the D1 (intersection of the apex of the canine tooth with the osteotomy line), D2 (the most prominent point of zygomatic buttress on the osteotomy line), and D3 (intersection of the midline of the second molar tooth with the osteotomy line) points increased. The lowest stress and displacement values were found in the 3 mm advancement model. As advancement increased, the highest values were found in the I plates. The stress levels on the plates and screws remained within safe limits., Conclusions: The von Mises stresses and displacement values tend to increase in according with the amount of advancement. More stress is transferred to posterior I plates and screws under dynamic forces., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

This study investigated the relationship between the direction of maxillary repositioning after Le Fort I osteotomy and changes in external nasal morphology using lateral cephalograms and frontal facial photographs. The results indicated greater changes in external nasal morphology, such as a more forward position of the nasal tip and an increased alar base width, with anterosuperior repositioning than with posterosuperior repositioning. In conclusion, this study demonstrated that the external nasal morphology changes after Le Fort I osteotomy, and that the changes vary depending on the direction of maxilla repositioning. [ABSTRACT FROM AUTHOR]

• The study provided an advanced finite element analysis with a comprehensive comparison and visualization of mechanical stresses, strains, and displacements, enhancing pre-surgical planning and prediction of post-operative outcomes. • Both the commercial and 3D-printed Ti6Al4V titanium plates showed close stress, strain, and displacement values under varying occlusal forces, indicating a marginal difference in biomechanical behaviors. • The 3D-printed Ti6Al4V plates demonstrated slightly lower displacement and strain under equivalent forces, suggesting a potential advantage in maintaining structural integrity post-operation. • Maximum stress concentrations were observed at the vertical change in the left posterior area between maxillary segments, with the 3D-printed model exhibiting higher stress values, potentially impacting long-term stability. • Our study supports the use of 3D-printed personalized fixation plates for their proven postoperative accuracy and excellent anatomical fit. However, in terms of mechanical stability, there is no significant difference under the 125, 250, 500 N/mm2 occlusal forces. To evaluate and compare the biomechanical behavior of three-dimensionally (3D) printed patient-specific Ti6Al4V with commercially made titanium mini plates following Lefort-I osteotomy using finite element analysis. Le Fort I osteotomy was virtually simulated with a 5 mm maxillary advancement and mediolateral rotation in the coronal plane, resulting in a 3 mm gap on the left side's posterior. Two fixation methods were modeled using software to compare 3D-printed Ti6Al4V and commercial titanium mini plates, both featuring a 4-hole l -shape with thicknesses of 0.5 mm and 0.7 mm at the strategic piriform rim and zygomaticomaxillary buttress locations. Using ANSYS R19.2, finite element models were developed to assess the fixation plates and maxilla's stress, strain, and displacement responses under occlusal forces of 125, 250, and 500 N/mm². This comparative analysis revealed slight variation in stress, strain, and displacement between the two models under varying loading conditions. Stress analysis indicated maximum stress concentrations at the vertical change in the left posterior area between maxillary segments, with the Ti6Al4V model exhibiting slightly higher stress values (187 MPa, 375 MPa, and 750 MPa) compared to the commercial titanium model (175 MPa, 351 MPa, and 702 MPa). Strain analysis showed that the commercial titanium model recorded higher strain values at the bending area of the l -shaped miniplate. Moreover, displacement analysis revealed a maximum of 3 mm in the left posterior maxilla, with the Ti6Al4V model demonstrating slightly lower displacement values under equivalent forces. The maximum stress, strain, and segment displacement of both fixation models were predominantly concentrated in the area of the gap between the maxillary segments. Notably, both fixation models exhibited remarkably close values, which can be attributed to the similar design of the fixation plates. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the maxillary anatomy in patients with cleft maxillary hypoplasia using computed tomogram. Materials and Methods: A cross-sectional observational study was carried out in all cleft patients reporting to our department for the correction of secondary cleft deformities. A preoperative computed tomogram of the midface (from the superior orbital rim to the maxillary occlusal plane) was recorded to assess the parameters which evaluate the maxillary and pterygomaxillary anatomy in cleft maxillary hypoplasia patients. Results: A total of 18 adult patients (female—5; male—13) were included in the study, which includes 15 unilateral and 3 bilateral cleft lip and palate patients. All the patients had undergone palatoplasty in their early childhood. Evaluation of the circum maxillary and pterygo-maxillary anatomy on the computed tomogram revealed that the average width of maxillary tuberosity was (mean—6.91 mm on cleft side, 4.51 mm on noncleft side); distance between medial and lateral pterygoid plates was (mean—6.45 mm on cleft side, 5.94 mm on noncleft side); distance from greater palatine foramen to posterior palatal border was (mean—5.6 mm on cleft side, 6.1 mm on noncleft side); distance from greater palatine foramen to pterygoid process was (mean—4.83 mm on cleft side, 5.6 mm on noncleft side); distance from pyriform rim to greater palatine foramen was (mean—30.0 mm on cleft side, 31.8 mm on noncleft side); inter pterygoid distance between medial pterygoid plates at the level of pterygoidhamulus was (mean—3.3 cms = 33 mm); inter pterygoid distance between medial pterygoid plates at skull base was (mean—3.0 = 30 mm) Conclusion: Maxillary hypoplasia in adult cleft patients distorts the circum maxillary and pterygomaxillary anatomy with cleft side being more hypoplastic compared to the noncleft side which needs to be evaluated prior to planning maxillary advancement. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to evaluate the outcomes of simultaneous LeFort I osteotomy and zygomatic/dental implant placement for oral rehabilitation of patients with extremely atrophic/dysmorphic edentulous maxilla. Simultaneous LeFort I osteotomy and zygomatic/dental implant placement was performed with patient-specific anatomical models and surgical guides produced through three-dimensional virtual planning methods. All patients received their final prosthesis, with immediate loading, on the day after surgery. The primary outcome variables were the implant survival rate, and the incidence of intra/postoperative complications. In total, 15 zygomatic implants and 33 conventional dental implants were inserted in eight patients. The mean follow-up of the patients was 38.5 months. The implant survival rate was 93.3% for zygomatic implants and 100% for dental implants. No intra/postoperative complications were observed. Simultaneous LeFort I osteotomy associated with zygomatic/dental implant surgery can be considered as a valuable treatment option for rehabilitation of patients with extremely atrophic edentulous maxilla and esthetic issues of the face. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the nasolabial soft tissues effects in three different Le Fort I osteotomy techniques using cone beam computed tomography (CBCT) evaluation of three-dimensional (3D) volume surfaces. A retrospective study was designed, and three groups were evaluated: group 1, patients who underwent conventional Le Fort I osteotomy; group 2, patients who underwent subspinal Le Fort I osteotomy; and group 3, patients who underwent conventional Le Fort I osteotomy with ANS recontouring or removal. CBCT evaluation was performed at two time points: T0, 1 week before surgery; T1, 6 months after surgery. A total of 90 patients were enrolled in this study (group 1: 30; group 2: 30; group 3: 30). Mean maxillary advancement was 4.26 mm. For group 1, mean change in inter-alar width was 2.29 ± 1.57 mm (minimum -2mm; maximum 6.1 mm; for group 2 it was 1.20 ± 1.56 mm (minimum −1.7 mm; maximum 5.9 mm), and for group 3 was 1.84 ± 1.76 mm (minimum −2.3 mm; maximum 5.9 mm). For group 1, mean change in alar base width was 1.69 ± 2.32 mm (minimum −4.8 mm; maximum 6,1 mm); in group 2 it was 0.85 ± 2.08 mm (minimum -4mm; maximum 6 mm), and group 3 was 1.21 ± 1.83 mm (minimum -2mm; maximum 5 mm). Results showed statistically significant differences in nasolabial area (P < 0.001). Within the limitations of the study it seems that subspinal Le Fort I osteotomy should be preferred when the priority is to avoid changes to the nasolabial region. [ABSTRACT FROM AUTHOR]