Three-dimensional Assessment of Facial Soft Tissue after Orthognathic Surgery in Patients with Skeletal Class III and Asymmetry

Purpose: The purpose of this study was to perform three-dimensional (3D) assessment of facial soft tissue in patients with skeletal Class III and mandibular asymmetry after orthognathic surgery. Methods: Samples consisted of 3D facial images obtained from five patients with A point-nasion-B point angle less than 2 degrees, and more than 5 mm of menton deviation. All patients had been treated at Gangneung-Wonju National University Dental Hospital from 2009 to 2012. They had undergone orthognathic surgery of Lefort I, and sagittal split osteotomy for correction of skeletal deformity, and orthodontic treatment. Facial scanning was performed before treatment (T1) and post-surgical orthodontic treatment (T2). Linear and angle variables of soft tissue landmarks, antero-posterior facial depth, and facial volume were measured. Results: No significant differences in width of the alar base, mouth width, and nasal canting were observed between T1 and T2. However, lip deviation, menton deviation, alar canting, lip canting, and menton deviation angle were significantly reduced at T2. Antero-posterior facial depth on the axial plane parallel to the left cheilion was significantly reduced on the deviated side and significantly increased on the non-deviated side at T2. Volume of the lower lateral and lower medial parts of the face was reduced on the deviated side, and volume of upper lateral and lower lateral parts on the non-deviated side was significantly increased at T2. Conclusion: After orthognathic surgery, facial asymmetry of soft tissue was improved following skeletal changes, especially the mandibular region. Although the length of the alar base and mouth width did not change, lip and soft tissue menton were displaced to the medial side after treatment. Facial depth also became symmetric after treatment. Facial volume showed a decrease on the lower part of the deviated side and that on lateral parts of the non-deviated side showed an increase after treatment.