Download Evaluation of Esthetic Parameters Following Orthognathic

Proceedings of the World Medical Conference
Evaluation of Esthetic Parameters Following
Orthognathic Surgery
Camelia Szuhanek, Eduard Gîdea Paraschivescu, Adriana Muntean, Roxana Rugina
Faculty of Dental Medicine,
University of Medicine and Pharmacy “Victor Babes”
Timisoara, ROMANIA
[email protected], [email protected], [email protected], [email protected]
Abstract—Skeletal anomalies of the face have a negative
effect on many aspects of life. These include social
interactions, opportunities, choice of profession, choice of
partner, and personality characteristics. The purpose of our
study was to analyse by esthetic parameters, the changes that
are taking place following surgical/orthodontic treatment.
Keywords—skeletal anomalies, orthognathic surgery,
esthetic parameters. facial balance.
I. INTRODUCTION
Smile is a highly relevant parameter for a beautiful face.
Currently, a pleasant smile, mainly influenced by the beauty
standards imposed by the media, is characterized by the
presence of perfectly aligned and leveled teeth in the dental
arches.
The aim of orthodontic surgical treatment of patients with
dentofacial deformities is to achieve a harmonious skeletal,
dental and soft-tissue relationship for the improvement of
facial esthetics and function.
The soft tissue change as a result of orthognathic surgery is
very important to the patient, and dental professionals must
bear that in mind when planning treatment Added to the
complexity of assessing orthognathic surgical treatment
outcome is the differing definition of beauty and facial
attractiveness by laypersons and clinicians.
Studies(Maple) have shown that the perception of facial
profile esthetics differs between patients, peers, and dental
professionals.The aim of our study was to evaluate the changes
in the esthetic parameters following surgical/orthodontic
treatment.
II SUBJECTS AND METHODS
Facial analysis
Facial form – The facial height Trichion(Tr) – soft tissue
menton(Me)/Bizygomatic
width(Za-Za)
should
be
1.3:1(females) and 1.35:1(males). The bigonial width shoudl
be about 30% less than the bizygomatic distance.
Vertical height - It has been well described that vertical
height can be evaluated by dividing the face into equal thirds.
Third superior (trichion-ophrion), third medium (ophrionsubnasale) and third bottom (subnasale-menton). For a
harmonious appearance, the three floors should be equal.
Symmetry - A midsagittal line is drawn and the symmetry
of the various points: cutaneous glabela, pronasale, labiale
upper and lower and cutaneous pogonion. The left/right half
should be equal.
Width - The easiest way to evaluate the relative width of
facial structures is to divide the face into vertical fifths with
each fifth being equal to one eye width. Also transverse
distances at bitemporal and bigonial lines should be equal and
approximately ten percent shorter than the bizygomatic line
drawn through the malar eminences.
Fig.1 Facial symmetry evaluation.
The study took place in the University of Medicine and
Pharmacy „Victor Babes” Timisoara, Departments of
Orthodontics and Cranio-Maxillo-Facial Surgery. 10 patients
who underwent orthognathic surgery were analysed by
facial/smile esthetic parameters in order to evaluate the
ISBN: 978-1-61804-036-7
treatment outcome. Frontal, lateral and intraoral parameters
were analysed.
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To assess the nose, a nose plot angle projection is measured
between a dorsal portion of the contact nose and perpendicular
to the horizontal cutaneous Frankfurt in nasion. The amount of
the angle is 36 degrees for i.e men of 34 degrees for women.
The nasolabial angle usually varies between between 85 and
105 degrees. The nasofrontal angle is formed at the nasion by
Proceedings of the World Medical Conference
lines that extend from this point to the glabella and to the nasal
tip. This angle should ideally be 120 to 135 degrees.
Evaluation of the upper and lower labial projections
should be assessed relative to a line drawn from the subnasal
point to the prominence of the chin. The upper lip should
extend approximately 3 to 3.5 mm anterior to this line, while
the lower lip should extend by only 1.5 to 2 mm. As a result,
the upper lip should project approximately 2 mm anterior to
the lower lip. However, the lower lip is fuller than the upper
lip by a ratio of 1.6:1.
Nose-Lips-Chin Position - At this point the relationship of
the nose, lips and chin to each other is evaluated using
Rickett's E (esthetic) line. This line is drawn from the nasal tip
to the pogonion. The lips should lie just posterior to this line
with the upper lip approximately twice as far from the line as
the lower lip. If this is the case, no further evaluation of these
structures is indicated at this time. If not, one of the three
structures is malpositioned.
III. RESULTS
The analysis of facial parameters in the surgical cases is
shown below.
Case 1
This 19 year old patient with severe openbite and class III
was treated with surgical/orthodontic approach. The surgery
consisted of a Le Fort I osteotomy impaction of the posterior
maxilla and bilateral sagittal split ramus osteotomy setback of
the mandible (Obwegeser DalPont). In a second phase,
genioplasty and rhinoplasty were performed in order to obtain
a good facial balance.
The evaluation of esthetic characteristics is shown below.
Fig. 3 Profile evaluation.Pre-surgery-Chin proeminence-the
Menton is situated on the naso-frontal line, the lips are
situated anteriorly to the facial plane.
Post-surgery: the Menton is situated posteriorly to the
nasofrontal line, the upper lip is anterior to the lower lip.
Pre-surgery esthetic analysis of the profile photo
revealed a concave profile angle and a nasolabial angle of 80°.
After the surgery the profile angle improved and the nasolabial
angle increased to a normal value of 95°.(fig.2,3).
The distance of the lower lip to the esthetic lie of Ricketts
increased from 3 mm at the beginning to 6,2 mm post-surgery.
The upper lip moved backwards from 5,1 mm pre-surgery to 7
mm post-surgery.
Fig. 4 Labio-nasal angle: pre-surgery 80°, post-surgery 100°.
Fig.2 Facial symmetry evaluation. Pre-surgical lower third of
the face showed frontal facial asymetry. Post-surgical
situation: a decreased inferior floor height.
The esthetic analysis of the initial frontal photo shows
an increased inferior floor and a facial midline slightly tilted to
the left. After the surgery, the dimension of the lower third of
the vertical height decreased.(fig.2).
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Fig5. Labiomental fold: pre-surgery 145°, post-surgery 135°.
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The frontal esthetic analysis of the initial photo(fig.7) showed
bipupilary and bicomisural lines tilted to the right and a frontal
asimetry due to the facial midline tilted to the left.
The final photo presenting the post-surgical situation showed a
decreased inferior third of the vertical dimension.
Fig.6 The nasal tip projection was 39° pre-surgery and 39°
post-surgery.
Fig. 9 Fig. 2 Profile evaluation.
Pre-surgery-Chin proeminence-the Menton is situated ahead to
the naso-frontal line, the lips are situated anteriorly to the
facial plane.Lower lip is ahead to the upper lip.
Post-surgery: the Menton is situated posteriorly to the
nasofrontal line, the upper lip is anterior to the lower lip.
Profile analysis of the pre-surgical estetic parameters revealed
a concave angle of the profile and a decreased nasolabial angle
of 87°.
The post-surgical situation presented in the second photo
showed a decreased value of the profile angle, a nasolabial
angle of 98° and an improved position of the upper and lower
lips to the esthetic line of Ricketts.
Fig. 7 The anteroposterior lip position to the lower facial
pane(subnasale-pogonion)
Pre-surgery upper lip 1 mm ahead, lower lip 3 mm ahead the
subnasale-pogonion line.
Post-surgery:upper lip 2 mm ahead, lower lip 1 mm ahead the
subnasale-pogonion line.
Case 2
was subjected to
This 28 year old female patient
surgical/orthodontic approach for the severe class III
malocclusion. The facial parameters significantly changed
following the surgical treatment.
Fig.10 The nasal tip projection was 87° pre-surgery and 98°
post-surgery.
Fig. 8 Facial symmetry evaluation. Pre-surgical analysis
showed frontal facial asymetry. Post-surgical situation:
decreased inferior third of the vertical dimension.
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malocclusion with mandibular asymmetry. Braz Dent J.
2011;22(2):151-6.
[3] Benyahia H, Azaroual MF, Garcia C, Hamou E, Abouqal
R, Zaoui F. Treatment of skeletal class III malocclusions:
orthognathic surgery or orthodontic camouflage? How to
decide. Int Orthod. 2011 Jun;9(2):196-209. Epub 2011 Apr 20.
[4] Tseng YC, Pan CY, Chou ST, Liao CY, Lai ST, Chen CM,
Chang HP, Yang YH. Treatment of adult Class III
malocclusions with orthodontic therapy or orthognathic
surgery: receiver operating characteristic analysis. Am J
Orthod Dentofacial Orthop. 2011 May;139(5):e485-93.
[5] Kang SH, Kim MK, Park SY, Lee JY, Park W, Lee SH.
Early orthognathic surgery with three-dimensional image
simulation during presurgical orthodontics in adults. J
Craniofac Surg. 2011 Mar;22(2):473-81.
[7] Maple JR, Vig KW, Beck FM, Larsen PE, Shanker S. A
comparison of providers’ and consumers’ perceptions of
facial-profile attractiveness. Am J Orthod Dentofacial Orthop.
2005;128:690–696.
[7] Nout E, Koudstaal MJ, Wolvius EB, Van der Wal KG.
Additional orthognathic surgery following Le Fort III and
monobloc advancement. Int J Oral Maxillofac Surg. 2011
Jul;40(7):679-84. Epub 2011 Mar 12.
[8] Liao YF, Chiu YT, Huang CS, Ko EW, Chen YR.
Presurgical orthodontics versus no presurgical orthodontics:
treatment outcome of surgical-orthodontic correction for
skeletal class III open bite. Plast Reconstr Surg. 2010
Dec;126(6):2074-83.
[9] Takahashi H., Furuta H., Moriyama S. : Assessment of
three bilateral sagittal split osteotomy techniques with respect
to mandibular biomechanical stability by experimental study
and finite element analysis simulation; Med.Bull. Fukuoka
Univ.: 36(3), 181-192, 200.9
[10] Tompach PC, Wheeler JJ,: Orthodontic considerations in
orthognathic surgery, Int. J Adult Orthoganth. Surg. 1995
[11] Szuhanek C., Paraschivescu E. - Interdisciplinary
surgical-orthodontic treatment of class III long face patients.
87th European Orthodontic Society Congress, 19-23th of June
2011, Istanbul, Turkey.
Fig.11 Labiomental fold: pre-surgery 148°, post-surgery
144°.
Fig. 12 The anteroposterior lip position to the lower facial
pane(subnasale-pogonion)
Pre-surgery upper lip 0.5 mm ahead, lower lip 2.5 mm ahead
the subnasale-pogonion line.
Post-surgery:upper lip 3 mm ahead, lower lip 2 mm ahead
the subnasale-pogonion line.
IV CONCLUSIONS
Facial esthetic parameters significantly changed following
surgical therapy. The esthetic outcome of the orthognatic
procedure has always been an important aspect in the
judgment of treatment success by both the clinician and the
patient.
Acknowledgement: This work was supported by CNCSIS–
UEFISCSU, project number PNII – IDEI 1738/2008-2011.
V. REFERENCES
[1] Barbosa AL, Marcantonio E, Barbosa CE, Gabrielli MF,
Gabrielli MA. Psychological evaluation of patients scheduled
for orthognathic surgery. J Nihon Univ Sch Dent. 1993;35
[2] Bergamo AZ, Andrucioli MC, Romano FL, Ferreira JT,
Matsumoto MA. Orthodontic-surgical treatment of class III
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Dr.Camelia Szuhanek was born in
Timisoara, Romania, on 25th of
November 1975. She is a specialist in
Orthodontics
and
Dentofacial
Orthopedics and received her DDS,
MSc and PhD degrees at the Faculty
of Dental Medicine, University of
Medicine and Pharmacy “Victor
Babes” Timisoara. She is currently an
Assistant Professor at the Department of Orthodontics and the
director of a research project on orthodontic biomechanics at
the University of Medicine and Pharmacy “Victor Babes”
Timisoara. She published over 140 articles in the field of
orthodontics. Dr.Szuhanek
maintains a private practice
limited to orthodontics in Timisoara, Romania. Her main
research interests are biomechanics, numerical analysis,
lingual orthodontics, multidisciplinary treatment and skeletal
anchorage.
Proceedings of the World Medical Conference
[email protected]
Consultant Dr. Gidea Paraschivescu
Eduard,PhD
born
in
Bucharest,Romania, on 27th of
September 1970. Specialist in CranioMaxillo-Facial Surgery, with 17 years
of experience, currently employed as
Assistant Professor at the "Victor
Babes" University of Medicine and
Pharmacy, Timisoara, Romania and
part time at the Municipal Hospital
Timisoara, as consultant CMF Surgeon.
Author and co-author of several books and articles, published
in Romania and abroad and over 50 papers in oral presentation
at national and international conferences and congresses. Chief
surgeon of the Cleft Children International Humanitarian
Mission in Niger, Africa, where he founded a Center of
Excellence
in
Cleft
Lip
and
Palate
Surgery.
Main fields of interest - orthognathic surgery, cleft surgery,
plastic surgery, oncology.
[email protected]
Dr. Adriana Muntean was born in
Rîmnicu Vîlcea, Romania, on 4th of June
1981. She is a postgraduate student in the
Department of Orthodontics and works as
an Assistant Professor in the Department
of Esthetic Dentistry from the University
of Medicine and Pharmacy Victor Babeş
Timişoara. She is author and coauthor of
several articles published in Romania and
abroad. Main fields of interest are esthetic
dentistry, multidisciplinary treatment, orthodontics and
skeletal anchorage.
[email protected]
Dr.Roxana Rugina was born in
Timisoara, Romania, on the 15th of June,
1986. She graduated the Faculty of Dental
Medicine, University of Medicine and
Pharmacy “Victor Babes” Timisoara. She
did an internship for three months at a
dental clinic in Rotterdam, Netherlands, in
2008. She published articles about
interdisciplinary
treatment,
severe
malocclusions and aesthetic analysis. She speaks fluently
german, dutch, english and french.
[email protected]
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