Three-dimensional comparison of nasal changes following segmented and non-segmented Le Fort I osteotomies.

BACKGROUND

Le Fort I osteotomy can lead to significant changes in nasal soft tissue, potentially affecting facial aesthetics. While previous studies have explored these effects, few have used three-dimensional photogrammetry or accounted for maxillary segmentation and movement.

OBJECTIVE

This retrospective matched case-control study compares nasal soft tissue changes one year after segmented versus non-segmented Le Fort I osteotomies using 3D stereophotogrammetry.

METHODS

Forty-nine patients who underwent segmented or non-segmented Le Fort I osteotomy between 2016 and 2021 were included. Pre- and one-year postoperative 3D VECTRA images were analyzed to assess nasal width and tip position. Subgroup analyses were performed based on maxillary advancement, intrusion, and extrusion.

RESULTS

Both groups showed consistent nasal base widening (1.9 mm in segmented vs. 2.3 mm in non-segmented), with no statistically significant differences. Segmented osteotomies were associated with a mean decrease in vertical nasal tip position (-4.1 mm), while non-segmented cases showed an increase (+ 2.2 mm). Vertical repositioning, rather than segmentation, had the greatest impact on nasal tip morphology.

CONCLUSION

Nasal base widening occurs consistently after Le Fort I osteotomy, regardless of segmentation. Segmentation did not exacerbate nasal changes and may even slightly reduce them. Vertical repositioning, particularly intrusion, is the main factor influencing nasal tip position. These findings support the importance of careful soft tissue management and informed patient counseling.