Facial soft tissue changes resulting from orthognathic surgery: a systematic review

Abstract

Background and Objectives: Orthognathic surgery can lead to significant changes in the facial aesthetics. Reliable predictions of the facial changes are crucial to match the expectation of the patients. Although a number of studies have addressed the postsurgical soft tissue changes, their results have not been systematically analysed. The aim of this study is to provide a systemic review of the facial soft tissue changes resulting from orthognathic surgery.

Methods: Several electronic databases (Medline, EMBASE, Cochrane Library, DARE and Scopus) were searched using a set of predetermined keywords. Full manuscripts meeting the inclusion criteria were retrieved and their references were manually searched for missing articles. Full texts of the selected studies were assessed on their methodological quality and were graded accordingly. The study details and outcome data of these reports were extracted using spreadsheets for comparison.

Results: Several imaging methods, including cephalometry, two-dimensional photography, stereophotogrammetry, laser scanning and computed tomography have been used to quantify the soft tissue changes. These changes and their ratios corresponding to the osseous movements resulting from different orthognathic procedures will be presented. Most studies evaluated horizontal and vertical facial changes, while reports on transverse changes were minimal. The other identified shortcomings of the studies were non-blinding of assessors, lack of long-term follow-up and small number of subjects.

Conclusion: Conventional cephalometric analyses do not have the capability of adequately evaluating three-dimensional facial soft tissue changes from orthognathic surgery. Long-term, prospective clinical trials with three-dimensional quantification are needed to provide sufficient information for predicting the soft tissue changes from orthognathic surgery.