Nasal anatomy and maxillary surgery. II. Unfavorable nasolabial esthetics following the Le Fort I osteotomy.

The Le Fort I osteotomy is among the most commonly performed orthognathic surgical procedures for correction of skeletal dysplasias. Numerous authors have described unfavorable nasal and labial changes following maxillary surgery, such as widening of the alar bases of the nose, upturning of the nasal tip, flattening and thinning of the upper lip, and downturning of the commissures of the mouth. These postoperative changes in nasolabial morphology are secondary to alterations in the regional anatomy following skeletal repositioning, cartilaginous resectioning, muscular retraction, and the resultant effects of these procedures on the overlying skin and subcutaneous tissues. In part I of this series a systematic method of evaluation and a detailed anatomic description of the nasolabial region were presented. This paper presents a series of cases with unfavorable nasal changes following Le Fort I osteotomies, analyzes each case in detail, and discusses the possible etiologies. Part III of this series will present techniques for handling of the skeletal, cartilaginous, and musculofascial components of the nasomaxillary region during the Le Fort I procedure to improve nasofacial esthetics and avoid unfavorable results.