Does Preoperative Supratip Soft-Tissue Thickness Predict Early Postoperative Edema Following Orthognathic Surgery? A Prospective Study Using Ultrasonography and 3-Dimensional Stereophotogrammetry.

BACKGROUND

Postoperative facial edema remains one of the most common early sequelae of orthognathic surgery, yet the contribution of intrinsic soft-tissue characteristics to postoperative swelling remains poorly understood. To our knowledge, this is the first prospective study to evaluate whether preoperative supratip soft-tissue thickness independently predicts early postoperative facial edema using high-resolution ultrasonography and longitudinal 3-dimensional stereophotogrammetry.

PURPOSE: To determine the independent effects of preoperative supratip soft-tissue thickness and surgical technique on early postoperative facial edema following orthognathic surgery.

STUDY DESIGN, SETTING, AND SAMPLE: This prospective, randomized, double-blind clinical study included 48 patients undergoing bimaxillary orthognathic surgery at a single tertiary referral center. Patients underwent either subspinal Le Fort I osteotomy (SLFI; n=22) or conventional Le Fort I osteotomy (CLFI; n=26). Preoperative supratip soft-tissue thickness was measured using high-resolution ultrasonography, whereas postoperative facial edema was serially quantified by 3-dimensional stereophotogrammetry. Multivariable linear regression with heteroscedasticity-consistent robust standard errors was performed to identify independent predictors of postoperative edema.

RESULTS

Patients treated with the SLFI exhibited significantly less postoperative edema than those treated with the CLFI throughout the early postoperative period, with the greatest between-group difference observed at peak swelling. Multivariable regression identified surgical technique as the sole independent predictor of postoperative edema. In contrast, preoperative supratip soft-tissue thickness was not independently associated with postoperative swelling after adjustment for age, sex, and body mass index and showed no significant predictive value at any postoperative time point.

CONCLUSIONS

Despite accurate preoperative quantification, supratip soft-tissue thickness was not an independent predictor of early postoperative facial edema. In contrast, surgical technique emerged as the principal independent predictor of postoperative swelling, suggesting that preservation-oriented approaches such as subspinal Le Fort I osteotomy may facilitate improved early soft-tissue recovery.