Simultaneous rhinoplasty and orthognathic double jaw procedures: How to get the nasolabial unit harmony

Abstract

The Le Fort I osteotomy is usually performed in order to reposition the maxilla and to correct any maxillary dentoskeletal deformity. This osteotomy is usually carried out through the transection of the perioral and perinasal musculature and through a wide periosteal degloving. What is really essential is a wide understanding of the anatomy of the interconnections between the hard framework and the soft tissues, and in particular of the muscular web, to manage, properly, the changes that a maxillary exposure and repositioning produce on the nose and on the upper lip. Secondary changes on the nasolabial unit that have occurred following this orthognathic procedure include the following: the widening of the alar bases; the upturning of the nasal tip with a subsequent increasing of the supratip depression; the alterations of the nasolabial angle; the increasing of the prominence of the alar groove; the flattening, the drooping, and the thinning of the upper lip; the reduction of the vermilion's exposure; and, finally, the downturning of the commissures of the mouth. Applying appropriate surgical techniques, many undesirable secondary changes can be prevented, maintaining the nose unchanged and achieving the aesthetic enhancement of the lip. This procedure permits the simultaneous performance of rhinoplasty and maxillomandibular osteotomies. The author discusses the nasolabial unit concept and the procedures necessary to achieve aesthetic results.