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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (5): 980-988. doi: 10.19723/j.issn.1671-167X.2025.05.025

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Comparation of anterior maxilla and whole maxilla clockwise rotation to improve paranasal aesthetic defects of skeletal Class Ⅲ maxillofacial deformity

Fengqi SONG, Xinyu XU, Xiaojing LIU, Zili LI*()   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
  • Received:2022-10-09 Online:2025-10-18 Published:2024-04-03
  • Contact: Zili LI
  • Supported by:
    the National Natural Science Foundation of China(82171012); Capital' s Funds for Health Improvement and Research(CFH2022-2-4104)

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Abstract: Objective: To compare the aesthetic effects of anterior maxilla clockwise rotation combined with segmental Le Fort Ⅰ osteotomy and whole maxilla clockwise rotation on improving paranasal concavity in patients with Class Ⅲ maxillofacial deformity. Methods: A non-randomized controlled trial was designed, and 21 patients diagnosed with skeletal Class Ⅲ maxillofacial deformity were included. In the study, 11 patients in the test group were treated by segmental Le Fort Ⅰ osteotomy combined with anterior maxilla clockwise rotation, and 10 patients in the control group were treated by whole maxilla clockwise rotation. The CBCT and 3D photography of preoperative (T0), 2 weeks postoperative (T1), and 6 months postoperative (T2) were collected respectively, and the three-dimensional cephalometry was carried out. The differences of specific parameters between the two groups were compared by independent sample t-test, including saggital displacement of the cheek mass point (CK) and subalare point (SA), nasolabial angle, occlusal plane angle and labial inclination angle of the upper incisor. Results: There were no significant differences of the parameters on T0 between the two groups. The average sagittal displacement of the upper incisors of the test group was (-0.71±1.67) mm and smaller than that of control group [(2.26±1.68) mm], t=-4.052, P < 0.05. The average angle of the occlusal plane clockwise rotation of the test group was 1.46°±2.38° and smaller than that of the control group (4.31°±1.83°), t=-3.047, P < 0.05. The angle of anterior maxilla clockwise rotation was 11.73°±2.81° during the surgery. The average saggital displacement of the paranasal soft tissue landmarks of the test group from T0 to T2 was larger than that of the control group [CK point, (4.96±1.18) mm vs. (2.01± 1.50) mm, P < 0.05;SA point, (5.19±1.17) mm vs. (2.69±1.45) mm, P < 0.05]. The labial inclination angle of the upper incisor of the test group was 112.15°±5.40° in T2 and significantly smaller than that of the control group (122.38°±8.83°), t=-3.237, P < 0.05. The nasolabial angle of the test group was 106.54°±12.82° in T2 and significantly larger than that of the control group (93.90°±12.46°), t=2.288, P < 0.05. Conclusion: Compared with whole maxilla clockwise rotation, anterior maxilla clockwise rotation combined with segmental Le Fort Ⅰ osteotomy can increase the saggital displacement of the paranasal soft tissue, correct labial inclination of the upper incisors and the acute naso-labial angle and better improve the paranasal aesthetic defects in patients with Class Ⅲ maxillofacial deformity with less changing on the saggital orientation of the upper incisors and the occlusal plane angle.

Key words: Skeletal Class Ⅲ maxillofacial deformity, Paranasal concavity, Segmental Le Fort Ⅰ osteo-tomy, Clockwise rotation, Three dimensional cephalometry

CLC Number: 

  • R782.1

Figure 1

Diagram of main landmarks in three-dimensional cephalometry A, landmarks of hard tissue; B, landmarks of soft tissue. The full names and explanations of all landmarks were listed in Table 1."

Table 1

Definition of the three-dimensional anatomical landmarks and reference planes"

Parameters Abbreviation Definition
Bone and dental landmarks
    Sella S The center of the hypophyseal fossa
    Nasion N The midpoint of the frontonasal suture
    Orbitale OrL, OrR The most inferior point of each infraorbital rim
    Porion PoL, PoR The most superior point of each external acoustic meatus
    Subspinale A The point of maximum concavity in the midline of the dento-alveolar process of the maxilla
    Upper incisor UI The most mesial point of the tip of the crown of the right upper central incisor
    Upper incisor apex UIa The apex of the right upper central incisor
    Upper molar UML, UMR The mesial buccal cusp of the first upper molar
    Supramental B The point of maximum concavity in the midline of the dento-alveolar process of the mandible
    Point h hL, hR Point on the left/right maxilla directly below the soft tissue alar base on axial view
Soft tissue landmarks
    Glabella G The most anterior midpoint on the fronto-orbital soft tissue contour
    Subalare SAL, SAR Labial insertion of each alar base
    Cheek mass CKL, CKR The most anterior point on the mid-pupillary plane (MPP) under infraorbital area and ahead of cornea perpendicular plane (CPP)
    Subnasale Sn The midpoint of the angle at the columella base where the lower border of the nasal septum and the surface of the upper lip meet
    Labiale superius Ls Midpoint of the upper vermillion border
    Columella peak Cp Most superior point of the columella
    Cornea CL, CR The most anterior point of the cornea
Reference planes
    Frankfort horizontal plane FHP The plane passes bilateral Orbitale and the midpoint between bilateral porion
    Midsagittal plane MSP The plane perpendicular to the FHP plane and passing through sella and nasion
    Facial plane FP The plane perpendicular to the FHP and MSP planes and passing through glabella
    Occlusal plane OP The plane passes the midpoint between UI and the midpoint between UML and UMR
    Mid-pupillary plane MPP The plane perpendicular to the FHP and FP planes and passing through cornea
    Cornea perpendicular plane CPP The plane perpendicular to the FHP and MSP planes and passing through cornea

Table 2

General characteristic and preoperative 3D cephalometric values of test group and control group"

Parameters Test group(n=11) Control group(n=10) t P value
Female 9 (81.8) 8 (80.0) -0.101 0.921
Age/years 24.91±6.20 24.00±5.06 0.366 0.719
SNA/(°) 82.47±2.28 81.26±2.89 1.067 0.299
SNB/(°) 85.90±2.46 86.45±2.74 -0.489 0.631
OP-SN/(°) 8.68±5.17 8.33±3.19 0.182 0.857
UI-SN/(°) 122.59±7.56 123.32±7.11 0.229 0.821
SNhR/(°) 72.07±2.91 71.50±4.30 0.364 0.720
SNhL/(°) 71.66±2.68 70.92±4.41 0.468 0.645
CKR-FP/mm -2.22±2.68 -3.04±3.44 0.614 0.546
CKL-FP /mm -3.01±3.26 -3.79±2.93 0.580 0.569
SAR-FP /mm -3.23±3.15 -4.51±3.20 0.921 0.369
SAL-FP /mm -4.16±3.01 -4.87±3.38 0.512 0.615
NL angle/(°) 87.61±14.62 84.63±12.97 0.491 0.629
UI-FP/mm 0.37±4.06 -1.42±3.96 1.020 0.320

Table 3

3D cephalometric values at T2 of test group and control group"

Parameters Test group (n=11) Control group (n=10) t P value
SNA/(°) 84.29±2.66 84.02±2.78 0.225 0.824
SNB/(°) 82.69±1.85 82.84±2.73 -0.142 0.889
OP-SN/(°) 10.26±4.64 11.62±3.92 -0.723 0.479
UI-SN/(°) 112.15±5.40 122.38±8.83 -3.237 0.004**
SNhR/(°) 78.48±2.77 76.16±3.83 1.600 0.126
SNhL/(°) 78.44±2.55 75.97±4.18 1.657 0.114
CKR-FP/mm 2.78±2.92 -1.21±3.31 2.932 0.009**
CKL-FP /mm 2.33±3.20 -1.60±3.25 2.793 0.012*
SAR-FP/mm 2.03±3.17 -1.32±2.95 2.507 0.021
SAL-FP/mm 2.23±3.73 -1.71±2.91 2.682 0.015*
NL angle/(°) 106.54±12.82 93.90±12.46 2.288 0.034*
UI-FP/mm 0.84±4.87 1.79±3.89 -0.494 0.627

Figure 2

Nasolabial angle and UI-SN of T0 and T2 in test group and control group A, variations of nasolabial angle from T0 to T2 of test group and control group; B, variations of UI-SN from T0 to T2 of test group and control group. Student-t test, * P＜0.05，* * P＜0.01. UI-SN, angle of the axis of the right upper incisor and SN line."

Table 4

Variation of 3D cephalometric values from T0 to T2 of test group and control group"

Parameters Test group (n=11) Control group (n=10) t P value
SNA/(°) 1.82±1.59 2.76±1.87 -1.245 0.228
SNB/(°) -3.21±1.04 -3.62±2.44 0.495 0.629
OP-SN/(°) 1.58±2.91 3.29±1.81 -1.597 0.127
UI-SN/(°) -10.43±4.28 -0.94±4.89 -4.746 ＜0.001**
SNhR/(°) 6.4±1.88 4.67±1.91 2.098 0.049*
SNhL/(°) 6.79±1.48 5.05±2.23 2.122 0.047*
CKR-FP/mm 4.78±1.22 1.83±1.55 4.886 ＜0.001**
CKL-FP /mm 5.15±1.74 2.19±1.63 4.005 ＜0.001**
SAR-FP /mm 5.24±1.71 3.18±1.67 2.782 0.012*
SAL-FP /mm 6.1±1.94 3.17±1.99 3.421 0.003**
NL angle/(°) 12.01±8.17 9.27±13.28 0.576 0.571
UI-FP/mm -0.03±1.95 3.05±2.44 -3.210 0.005**

Figure 3

Saggital displacement of paranasal soft tissue landmarks from T0 to T2 Student-t test, * P＜0.05，* * P＜0.01, * * * P＜0.001. The definition of the parameters were listed under Table 2."

Figure 4

Photographs and X-ray of a patient in test group before (T0) and 6 months after surgery (T2) A-D, frontal photograph, 45° right side photograph, right lateral photograph and cephalometric lateral radiographs of T0; E-H, frontal photograph, 45° right side photograph, right lateral photograph and cephalometric lateral radiographs of T2."

Figure 5

Photographs and X-ray of a patient in control group before (T0) and 6 months after surgery (T2) A-D, frontal photograph, 45° right side photograph, right lateral photograph and cephalometric lateral radiographs of T0; E-H, frontal photograph, 45° right side photograph, right lateral photograph and cephalometric lateral radiographs of T2."

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