An orthodontic-orthognathic patient with obstructive sleep apnea treated with Le Fort I osteotomy advancement and alar cinch suture combined with a muco-musculo-periosteal V-Y closure to minimize nose deformity

ABSTRACT In some severe skeletal Class III patients, mandibular setback surgery using sagittal split ramus osteotomy (SSRO) is performed to correct mandibular protrusion. However, in patients diagnosed with obstructive sleep apnea syndrome (OSAS), the risk of OSAS worsening as a result of the SSRO is very high. Maxillary advancement could reduce the degree of mandibular retropositioning and expand the skeletal framework in the pharyngeal region, leading to enlargement of the airway. However, nasal deformity is an undesirable outcome of the procedure. This case report describes a 23-year-old man with a retruded maxilla and OSAS. The maxillary retrusion was treated using Le Fort I osteotomy with an alar cinch suture and a muco-musculo-periosteal V-Y closure (ACVY). After treatment, better occlusal relationships and improvement in OSAS were observed. Thus, an ACVY could minimize nasolabial deformity.

Nasal Changes after Surgical Correction of Skeletal Class III Malocclusion in Koreans

Objective: To quantify the changes in the nose after bimaxillary surgery to correct skeletal Class III malocclusion and to test the hypothesis that there is no change in the nasal width following bimaxillary surgical correction of skeletal Class III when a nasal cinch is properly used. Materials and Methods: Sixty-five adult Korean skeletal Class III patients who had received maxillary advancement/impaction and mandibular set-back surgery in conjunction with an alar base cinch suture were evaluated. The anthropometric variables of the nasal region were measured directly on the soft-tissue surface before and 6 months after surgery. Results: After surgery, the alar width and alar base width had increased significantly (P < .001), while the nasal tip projection decreased (P < .001). The nostril morphology also showed widening (P < .001). There was a trend for females with a narrow alar width presurgically to have a larger amount of nasal widening compared with those with a broader alar width (P < .05). Conclusion: There is a high probability of nasal and nostril widening after bimaxillary surgery for skeletal Class III malocclusion in Koreans despite the careful performance of alar cinch suture. Nevertheless, the authors believe that alar cinch suture was positive in limiting the nasal widening to the minimum and would consider routine application during bimaxillary surgery for skeletal Class III especially for female patients with a narrow nose who are susceptible to these changes.