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Three-dimensional nasolabial changes after maxillary advancement osteotomy in class III individuals: a systematic review and meta-analysis

A Correction to this article was published on 24 June 2022

This article has been updated


Background Class III malocclusions with maxillary retrognathia are commonly treated with single jaw Le Fort I maxillary advancement. The three-dimensional (3D) effects of surgery on the nasolabial region varies among the clinical studies. Quantifying these changes is of great importance for surgical planning and obtaining valid consent.

Objectives To investigate the 3D relationship between soft tissue and skeletal changes secondary to Le Fort I maxillary advancement surgery in skeletal class III patients.

Search methods Comprehensive search of multiple electronic databases supplemented by a manual and grey literature search were undertaken from inception to 9 June 2020.

Selection criteria Studies that evaluated the 3D soft tissue changes of patients before and after maxillary advancement surgery alone.

Data collection and analysis Study selection, data extraction and risk of bias assessment were performed independently by two reviewers, with disputes resolved by a third reviewer. A quantitative synthesis of the data was pre-planned for pooling similar outcome measures.

Results Four studies were included in the final review and meta-analysis, with a total of 105 patients (mean age 16.7 + 33.9 years). The mean maxillary advancement of the included studies was 5.58 mm (95% CI 5.20-5.96). The sagittal effects of surgery on nose tip projection and prominence were insignificant (P >0.05, two studies); however, subnasal projection (MD 1.7 mm, two studies) and upper lip projection (MD 2.90 mm, four studies) increased significantly in a forward direction after surgery (P <0.05). Le Fort I osteotomy widens the upper philtrum width (MD 0.84 mm, two studies) (P <0.05). Inconsistencies among the included studies were identified; therefore, the results should be interpreted with caution.

Conclusions There is weak evidence based on quantitative assessments that Le Fort I maxillary advancement significantly affects the nasolabial soft tissue envelope mainly in a sagittal dimension. These changes are concentrated around the central zone of the nasolabial region. Future prospective studies on maxillary advancement osteotomy with a standardised method of assessment, taking into consideration the confounding factors, are required.

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The data underlying this article are available in the article and in its online supplementary material. No funding was received for this paper.

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Authors and Affiliations



MA, HM, AU and JR designed the study and guided the protocol development. MA, HM and AU supervised this work. MA and SM performed the updated search of literature. JR and AU undertook study selection while MA was involved as a third reviewer in this process. JR and MA performed the data extraction while AU was involved as a third reviewer in this process. SM and MA judged the methodological quality while MW was involved as a third reviewer in this process. SM, AU, MA and MW analysed the data and worked on data interpretation. All authors carried out manuscript writing, refining the manuscript, and read and approved the final manuscript.

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Correspondence to Samer Mheissen.

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Almuzian, M., Rowley, J., Mohammed, H. et al. Three-dimensional nasolabial changes after maxillary advancement osteotomy in class III individuals: a systematic review and meta-analysis. Evid Based Dent (2021).

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