Soft tissue response and facial symmetry after orthognathic surgery

Objective: In orthognathic surgery aesthetic issues and facial symmetry are vital parameters in surgical planning. Aim of this investigation was to document and analyze the results of orthognathic surgery on the base of a three-dimensional photogrammetric assessment, to assess the soft tissue response related to the skeletal shift and the alterations in facial symmetry after orthognathic surgery. Patients and methods: In this prospective clinical trial from January 2010 to June 2011, 104 patients were examined who underwent orthognathic surgery due to mono- or bimaxillary dysgnathia. The standardized measurements, based on optical 3D face scans, took place one day before orthognathic surgery (T1) and one day before removal of osteosynthesis material (T2). Results: Soft tissue changes after procedures involving the mandible showed significant positive correlations and strong soft tissue response (p < 0.05). The midfacial soft tissue response after maxillary advancement was only of minor extent (p > 0.05). The facial surfaces became more symmetric and harmonic with the exception of surgical maxillary expansion, but improvement of facial symmetry revealed no statistical significance. Conclusion: Soft tissue response after orthognathic surgery and symmetry are only partially predictable, especially in the maxillary and midfacial region. Computer programs predicting soft tissue changes are not currently safely reliable and should not be used or with caution to demonstrate a patient potential outcome of surgery. (C) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.