Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2026
Effect of Sagittal Maxillary Rotation on Inferior Scleral Exposure in Class III Maxillary Deficiency.
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Suzen Muazzez, Ozel Abdullah, Munevveroglu Mine Cihan, Uckan Sina
Аннотация
BACKGROUND: Inferior scleral exposure (ISE) is an important determinant of periorbital esthetics and overall facial harmony. While effects of linear maxillary movements are documented, influence of sagittal-plane maxillary rotational vectors on ISE remains insufficiently investigated.
PURPOSE: The purpose of this study was to measure the association between sagittal-plane maxillary rotational changes and ISE in subjects undergoing LeFort I osteotomy.
STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study was conducted at Medipol Mega University Hospital (Istanbul, Türkiye) and included subjects treated with LeFort I osteotomy for Class III maxillary deficiency between 2019 and 2022. Subjects were excluded if anterior vertical maxillary repositioning exceeded ±2.5 mm (impaction or inferior maxillary repositioning) or if they had craniofacial syndromes, prior midface surgery, or inadequate preoperative or postoperative photographic records.
PREDICTOR VARIABLE: Primary predictor was sagittal occlusal plane rotational change, measured in degrees (positive values indicating clockwise [CW] and negative values indicating counterclockwise [CCW] rotation).
MAIN OUTCOME VARIABLE: Primary outcome was the change in ISE between preoperative and postoperative assessments, evaluated using vertical distance from the pupil center to the lower eyelid margin and by pixel-based measurement of visible scleral area.
COVARIATES: Covariates included age and sex, sagittal maxillary advancement, and vertical maxillary repositioning.
STATISTICAL ANALYSIS: Preoperative and postoperative differences in ISE were assessed using paired t-tests. Between-group comparisons were performed using independent samples t-tests. Correlation analysis evaluated associations between sagittal rotation and changes in ISE. Statistical significance was set at P < .05.
RESULTS: The study included 42 subjects of whom 15 (35.7%) were male (mean age, 25 ± 7 years). Mean sagittal occlusal plane rotation was -2.2 ± 1.8° in CCW group and 3.2 ± 2.5° in CW group. ISE statistically significantly decreased postoperatively in CW group (P = .005-.041), whereas no statistically significant change was observed in CCW group. Sagittal rotational magnitude was not correlated with scleral change (r = -0.12 to -0.15; P = .5-.9). Vertical maxillary repositioning remained significantly associated with scleral reduction (P = .02), while sagittal rotation was not an independent predictor.
CONCLUSIONS: Although CW maxillary rotation was associated with reduced ISE in univariate analysis, vertical repositioning was a significant independent predictor. These findings emphasize importance of considering multiple vector components during virtual orthognathic surgical planning.
PURPOSE: The purpose of this study was to measure the association between sagittal-plane maxillary rotational changes and ISE in subjects undergoing LeFort I osteotomy.
STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study was conducted at Medipol Mega University Hospital (Istanbul, Türkiye) and included subjects treated with LeFort I osteotomy for Class III maxillary deficiency between 2019 and 2022. Subjects were excluded if anterior vertical maxillary repositioning exceeded ±2.5 mm (impaction or inferior maxillary repositioning) or if they had craniofacial syndromes, prior midface surgery, or inadequate preoperative or postoperative photographic records.
PREDICTOR VARIABLE: Primary predictor was sagittal occlusal plane rotational change, measured in degrees (positive values indicating clockwise [CW] and negative values indicating counterclockwise [CCW] rotation).
MAIN OUTCOME VARIABLE: Primary outcome was the change in ISE between preoperative and postoperative assessments, evaluated using vertical distance from the pupil center to the lower eyelid margin and by pixel-based measurement of visible scleral area.
COVARIATES: Covariates included age and sex, sagittal maxillary advancement, and vertical maxillary repositioning.
STATISTICAL ANALYSIS: Preoperative and postoperative differences in ISE were assessed using paired t-tests. Between-group comparisons were performed using independent samples t-tests. Correlation analysis evaluated associations between sagittal rotation and changes in ISE. Statistical significance was set at P < .05.
RESULTS: The study included 42 subjects of whom 15 (35.7%) were male (mean age, 25 ± 7 years). Mean sagittal occlusal plane rotation was -2.2 ± 1.8° in CCW group and 3.2 ± 2.5° in CW group. ISE statistically significantly decreased postoperatively in CW group (P = .005-.041), whereas no statistically significant change was observed in CCW group. Sagittal rotational magnitude was not correlated with scleral change (r = -0.12 to -0.15; P = .5-.9). Vertical maxillary repositioning remained significantly associated with scleral reduction (P = .02), while sagittal rotation was not an independent predictor.
CONCLUSIONS: Although CW maxillary rotation was associated with reduced ISE in univariate analysis, vertical repositioning was a significant independent predictor. These findings emphasize importance of considering multiple vector components during virtual orthognathic surgical planning.