The Impact of Orthognathic Surgery on Nasal Morphology: A Systematic Review

Orthognathic surgery, particularly procedures involving the maxilla, plays a crucial role in correcting dentofacial deformities. However, it also has significant and often unintended effects on nasal morphology. Among these procedures, the Le Fort I osteotomy is the most commonly associated with changes in the nasal tip projection, the width of the alar base, and the nasolabial angle. These alterations can impact both facial aesthetics and nasal function, sometimes requiring additional interventions such as simultaneous or secondary rhinoplasty. This systematic review examines the ways in which orthognathic surgery affects nasal morphology, explores the underlying mechanisms driving these changes, and discusses strategies to predict and control postoperative outcomes. Additionally, the review highlights the role of adjunctive surgical techniques, including alar cinch sutures and V-Y closure, in optimizing both aesthetic and functional results.

Background: Orthognathic surgery significantly affects nasal morphology, influencing both aesthetic and functional outcomes. However, the extent and predictability of these changes remain subjects of debate.

Objective: This study aims to analyze the impact of maxillo-mandibular osteotomies on nasal structures, assessing their influence on nasal width, tip projection, and airway function.

Methods: A retrospective analysis was conducted on patients undergoing orthognathic surgery with concurrent cephalometric and photographic evaluations. Changes in nasal morphology were assessed preoperatively and postoperatively using standardized imaging and clinical measurements.

Results: Maxillary advancement and impaction were associated with increased alar width and decreased nasolabial angle, while mandibular repositioning had minimal nasal effects. The inclusion of adjunctive procedures, such as alar cinch sutures and septoplasty, played a crucial role in controlling nasal alterations. Functional outcomes revealed improved nasal breathing in cases with concomitant septoplasty.

Conclusion: Orthognathic surgery introduces predictable yet variable nasal modifications, emphasizing the need for preoperative planning to optimize both aesthetic and functional results. The integration of nasal procedures can enhance surgical outcomes, preventing undesirable changes in nasal morphology.