Three-dimensional laser scanner evaluation of facial soft tissue changes after LeFort I advancement and rhinoplasty surgery: patients with cleft lip and palate vs patients with nonclefted

Objective. The aim of this study was to analyze the differences in facial soft tissue changes, despite the same extent of upper jaw forward movement, between patients with unilateral cleft lip and palate (uCLP) and those without, after LeFort I osteotomy and secondary rhinoplasty. Study Design. Twelve patients with maxillary retrognathic dysplasia and nose deformity were divided in 2 groups, A (uCLP) and B (control), and compared on the basis of the same maxillary advancement. Cephalometry and 3D mean facial model of groups A and B were obtained before and after surgery. Linear and angular measurements were calculated. Results. Upper vermilion and alar base remained unchanged in group A but increased in group B. In both groups, symmetry of the nasal base was improved, and an increase of the sagittal projection of the lips was observed. Conclusions. 3D analysis showed that surgical procedures for uCLP can provide a satisfactory aesthetic outcome, but some differences are evident in comparison with the control group. (Oral Surg Oral Med Oral Pathol Oral Radiol 2014;117:416-423) Improvement of facial aesthetics is one of the primary objectives of modern orthognathic surgery; attractiveness is a major component of the self-concept. The appearance of the face has been found to influence the social acceptance and psychological well-being of the individual. In the literature, it has been reported that symmetrical body shape is a central cue for attractiveness. 1-3 Thus, patients with cleft lip and palate (CLP) are at potential disadvantage. 3,4 The cleft malformation shows a variety of interindividual shapes. Even in those who received surgery followed by therapeutic rehabilitation early in infancy, adult patients with CLP often show secondary deformities in the maxillary and nasal regions. These deformities may consist of defects that are unrepaired in primary surgery and distortions that develop through growth or are caused by residual scars. Clinical examination usually finds upper lip scars from previous corrective plastic surgery, maxillary hypoplasia, difference in lip length, and nasal deformities, which can vary from almost invisible to catastrophic, mostly dependent on the severity and type of cleft 5 and on the ability of the cleft-repairing surgeon. Nose distortions include a deviated columella, a depressed and deviated nasal tip, dislocation of the alar cartilage, webbing at the alar rim, flat and V-shaped nostrils, and scarring or