Clinical Efficacy Of Modified Le Fort Ⅰ Osteotomy To Improve Midfacial Morphology In Patients With Skeletal Class Ⅲ Malocclusion

Objective:In this study,a Modified Arc Le Fort I Osteotomy(MALI)was introduced to provide a one-stop treatment plan for patients with Skeletal Class Ⅲ malocclusion accompanied by facial depressions.First,compare it with the traditional Le Fort I osteotomy(LFI)to explore whether it can effectively increase the facial fullness of patients;Secondly,observe its impact on postoperative patient satisfaction and aesthetic evaluation among different groups,and analyze its impact on patient appearance.The aim of this study is to investigate whether the modified Arc Le Fort I osteotomy can improve the clinical efficacy of the treatment of midfacial depression in Skeletal Class Ⅲ patients.Methods:From April 2018 to April 2022,19 patients with Skeletal Class Ⅲ malocclusion male(MALI group)who underwent modified curved Le Fort I osteotomy and 21 patients with Skeletal Class Ⅲ malocclusion male(LFI group)who underwent traditional Le Fort I osteotomy in our hospital were enrolled.Electronic medical records,facial photographs and spiral CT imaging data were collected at 1 week before surgery(T0),1 week after surgery(T1)and 1 year after surgery(T2).Pro Plan software was used to construct a three-dimensional reconstruction model of soft and hard tissues of the head,and a stable three-dimensional rectangular coordinate system was established.The forward distance and rotation Angle of the maxilla were measured at T1,and the facial shape,the volume of midface and the position of the soft tissue landmarks of the midface were measured at T0 and T2.The changes of facial shape,midface volume,midface asymmetry,and sagittal movement distance of 18 midface soft tissue landmarks were analyzed from one week before surgery to one year after surgery.One year after surgery,the patients were asked to score the median satisfaction of the face,and the correlation between the questionnaire score and the measurement results was analyzed by Spearman correlation analysis.Finally,scale scoring method was used to allow different groups of people to evaluate the aesthetic evaluation of patients’ facial photos at T0 and T2.Results:In the MALI group,the volume change of midface from T0 to T2 was 4.16 cm~3,the volume change ratio of midface was 3.16%,the asymmetry of midface was 0.16cm~3,the postoperative patient satisfaction questionnaire score was 4.16,the postoperative mid-face aesthetic score was 77.32,and the postoperative mid-face comfort score was 78.6.Compared with the LFI group(3.06 cm~3;2.40%;0.17 cm~3;3.48;71.57;74.14)were statistically significant(p < 0.05).The results showed that compared with the LFI group,the MALI group had a higher degree of improvement in the volume and position of midface,patient satisfaction,and aesthetic evaluation,and a lower postoperative midface asymmetry.Conclusions:Compared with the traditional Le Fort I osteotomy,the Modified Arc Le Fort I Osteotomy can significantly increase the mid-face fullness,improve the position and symmetry of the mid-face after surgery,and improve the postoperative satisfaction and aesthetic evaluation of patients with Skeletal Class Ⅲ malocclusion with mid-face depression.The Modified Arc Le Fort I Osteotomy provides a new surgical scheme for the simultaneous correction of the abnormal spatial position of the maxilla and the aesthetic defects in the middle of the face.