The Effects of Maxillary Movement on Nasal Septum and Internal Nasal Valve Following Le Fort I Osteotomy: A CBCT study

Main Article Content

Pornpop Rattana-arpha

Abstract

Abstract


Objective: Le Fort I osteotomy (LF-IO) is a technique for the correction of dentofacial deformities, resulting in significant anterior nasal change. This study aimed to investigate the effect of different maxillary movements on the nasal septum (NS) and internal nasal valve (INV) after LF-IO with cone beam computed tomography (CBCT) images. Materials and Methods: A retrospective study including 39 patients who underwent LF-IO and received CBCT
pre-operatively and 6-to-12-month post-operative evaluation was performed. All patients were divided into three groups according to their maxillary movement direction. Group 1 underwent maxillary advancement, group 2 underwent maxillary impaction, and group 3 (combination) underwent both maxillary advancement and impaction. NS angle at nasion level, INV angle, and INV area at pre-operative and post-operative period on CBCT images were measured and evaluated. Results: The median of NS angle and the mean INV angle had a significant increase post-operatively in all three groups. However, INV area showed no statistically significant change after surgery. When the amount of the changes among the three groups were compared, the results revealed no statistically significant change in all three groups. Correlation between changes of NS angle and the magnitude of maxillary advancement was moderately positive with statistically significant difference. Conclusions: Advancement and impaction of maxilla in LF-IO influenced an increase in the NS angle and INV angle. A moderately positive correlation between changes of NS angle and the magnitude of maxillary advancement was found.

Article Details

Section
นิพนธ์ต้นฉบับ (Original Article)

References

References

Kramer FJ, Baethge C, Swennen G, Teltzrow T, Schulze A, Berten J, et al. Intra- and

perioperative complications of the Le Fort I osteotomy: A prospective evaluation of 1000

patients. J Craniofac Surg. 2004;15(6):971–77.

Eliason MJ, Schafer J, Archer B, Capra G. The Impact on Nasal Septal Anatomy and Physiology

Following Le Fort I Osteotomy for Orthognathic Surgery. J Craniofac Surg. 2021;32(1):277-81.

Hilberg O. Objective measurement of nasal airway dimensions using acoustic rhinometry:

methodological and clinical aspects. Allergy. 2002;57(70):5-39.

Rattana-arpha P, Boonsiriseth K, Kretapirom K, Kriangcherdsak Y. Assessment of Nasal Septum

Change after Le Fort I Osteotomy Using Cone Beam Computed Tomography. J Maxillofac Oral

Surg. 2023;22(4):799-805.

Suh MW, Jin HR, Kim JH. Computed tomography versus nasal endoscopy for the

measurement of the internal nasal valve angle in Asians. Acta Otolaryngol. 2008;128(6):675-9.

Harris D, Horner K, Gröndahl K, Jacobs R, Helmrot E, Benic GI, et al. EAO guidelines for the use

of diagnostic imaging in implant dentistry 2011. A consensus workshop organized by the

European Association for Osseointegration at the Medical University of Warsaw. Clin Oral Implants Res. 2012;23(11):1243-53.

Bloom JD, Sridharan S, Hagiwara M, Babb JS, White WM, Constantinides M. Reformatted

computed tomography to assess the internal nasal valve and association with physical

examination. Arch Facial Plast Surg. 2012;14:331-5.

Poetker DM, Rhee JS, Mocan BO, Michel MA. Computed tomography technique for evaluation

of the nasal valve. Arch Facial Plast Surg. 2004;6:240-3.

Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation.

Anesth Analg. 2018;126(5):1763-8.

On SW, Baek SH, Choi JY. Quantitative Evaluation of the Postoperative Changes in Nasal

Septal Deviation by Diverse Movement of the Maxilla After Le Fort I Osteotomy. J Craniofac

Surg. 2020;31(5):1251-5.

Posnick JC, Fantuzzo JJ, Troost T. Simultaneous intranasal procedures to improve chronic

obstructive nasal breathing in patients undergoing maxillary (le fort I) osteotomy. J Oral

Maxillofac Surg 2007;65(11):2273–81.

Shin YM, Lee ST, Kwon TG. Surgical correction of septal deviation after Le Fort I osteotomy.

Maxillofac Plast Reconstr Surg. 2016;38(1):21

Verse T, Pirsig W. Impact of impaired nasal breathing on sleepdisordered breathing.

Sleep Breath. 2003;7:63–6.

Lepley TJ, Frusciante RP, Malik J, Farag A, Otto BA, Zhao K. Otolaryngologists' radiological

assessment of nasal septum deviation symptomatology. Eur Arch Otorhinolaryngol.

;280(1):235-40.

Aziz T, Biron VL, Ansari K, Flores-Mir C. Measurement tools for the diagnosisof nasal septal

deviation: a systematic review. J Otolaryngol Head Neck Surg. 2014;43(1):11.

Mamikoglu B, Houser S, Akbar I, Ng B, Corey JP. Acoustic rhinometry and computed

tomography scans for the diagnosis of nasal septal deviation, with clinical correlation.

Otolaryngol Head Neck Surg. 2000;123(1):61–8.

Chandra RK, Patadia MO, Raviv J. Diagnosis of nasal airway obstruction. Otolaryngol Clin

North Am. 2009;42(2):207-25.

Aung SC, Foo CL, Lee ST. Three dimensional laser scan assessment of the oriental nose with

a new classification of Oriental nasal types. Br J Plast Surg. 2000;53(2):109-16.

Shia Ng L, Lo S. Management of the internal nasal valve. Int J Otorhinolaryngol Clin.

;5(1):43-5.

Egan KK, Kezirian EJ, Kim DW, Nasal obstruction and sleep-disordered breathing. Oper Tech

Otolaryngol. 2006;17:268-72.

Moche JA, Cohen JC, Pearlman SJ. Axial computed tomography evaluation of the internal

nasal valve correlates with clinical valve narrowing and patient complaint. Int Forum Allergy

Rhinol. 2013;3(7):592-7.

Mladina R, Cujić E, Subarić M, Vuković K. Nasal septal deformities in ear, nose, and throat

patients: an international study. Am J Otolaryngol. 2008;29(2):75-82.

Dilaver E, Ak KB, Süzen M, Altın G, Uçkan, S. Evaluation of internal nasal valve using

computed tomography after Le Fort I osteotomy: A cross-sectional study from a tertiary

center. Med Bull Haseki. 2021;59(5):400-4.

Yoon A, Abdelwahab M, Liu S, Oh J, Suh H, Trieu M, et al. Impact of rapid palatal expansion

on the internal nasal valve and obstructive nasal symptoms in children. Sleep Breath.

;25(2):1019-27.

Baeg SW, Hong YP, Cho DH, Lee JK, Song SI. Evaluation of Sinonasal Change After Lefort I

Osteotomy Using Cone Beam Computed Tomography Images. J Craniofac Surg.

;29(1):e34-e41.

Atakan A, Ozcirpici AA, Pamukcu H, Bayram B. Does Le Fort I osteotomy have an influence

on nasal cavity and septum deviation?. Niger J Clin Pract. 2020;23(2):240-5.

Nocini PF, D'Agostino A, Trevisiol L, Favero V, Pessina M, Procacci P. Is Le Fort I Osteotomy

Associated With Maxillary Sinusitis?. J Oral Maxillofac Surg. 2016;74(2):400.e1-400.e12.

Valstar MH, Baas EM, Te Rijdt JP, De Bondt BJ, Laurens E, De Lange J. Maxillary sinus recovery

and nasal ventilation after Le Fort I osteotomy: a prospective clinical, endoscopic, functional

and radiographic evaluation. Int J Oral Maxillofac Surg. 2013;42(11):1431-6.

Erbe M, Lehotay M, Gode U, Wigand ME, Neukam FW. Nasal airway changes after Le Fort I—

Impaction and advancement: anatomical and functional findings. Int J Oral Maxillofac Surg.

;30(2):123–9.

Honrado CP, Lee S, Bloomquist DS, Larrabee WF Jr. Quantitative assessment of nasal

changes after maxillomandibular surgery using a 3-dimensional digital imaging system. Arch

Facial Plast Surg. 2006;8(1):26-35.

Ghoreishian M, Gheisari R. The effect of maxillary multidirectional movement on nasal

respiration. J Oral Maxillofac Surg. 2009;67(10):2283-6.

Haarmann S, Budihardja AS, Wolff KD, Wangerin K. Changes in acoustic airway profiles and

nasal airway resistance after Le Fort I osteotomy and functional rhinosurgery: a prospective

study. Int J Oral Maxillofac Surg. 2009;38(4):321-5.

Pourdanesh F, Sharifi R, Mohebbi A, Jamilian A. Effects of maxillary advancement and

impaction on nasal airway function. Int J Oral Maxillofac Surg. 2012;41(11):1350-2.

Howley C, Ali N, Lee R, Cox S. Use of the alar base cinch suture in Le Fort I osteotomy: is it

effective?. Br J Oral Maxillofac Surg. 2011;49(2):127-30.