Objective: To determine the changes in the position and area of nasal and labial soft tissues in adult skeletal Class III patients who underwent bimaxillary orthognathic surgery. Materials and Methods: Pretreatment (T1), preoperative (T2), and posttreatment (T3) cephalometric variables and upper-lower lip areas were measured on lateral cephalometric radiographs for 20 individuals (9 male, 11 female; mean age 21.3 years at T1, 22.4 years at T2, and 23.4 years at T3) who had maxillary advancement and mandibular setback. Analysis of variance (ANOVA) and Duncan tests were used to compare the cephalometric and area measurements at the beginning of treatment, and at presurgery and postsurgery, respectively. Paired t-tests were also performed to analyze changes within the periods. Results: The tip of the nose was affected less with the movement of the underlying skeletal structure (0.25%), while the soft tissue B point (B′) moved equally with the skeletal B point. As the maxilla related variables increased due to the forward movement, the upper labial areas decreased. With the backward movement of the mandible, the middle and inferior lower labial areas increased, while the superior lower labial area decreased. Conclusions: The results of our study suggest that the dramatic improvement in the facial profiles of the bimaxillary surgery patients is primarily related to the backward movement of the mandible and the significant reduction in the superior lower lip area.

Objective: To evaluate the adaptive changes and the stability in tongue posture following rapid maxillary expansion (RME) in patients without any signs or symptoms of respiratory disturbances. Materials and Methods: Growing subjects with maxillary constrictions and bilateral buccal crossbites were included in the treatment group (n = 20). A control group (n = 20) comprised subjects with normal dentoskeletal features. RME appliances were used in the treatment group, with an average active expansion of 15 ± 2 days. Cephalometric radiographs were traced and digitized to evaluate static tongue posture before RME and 6.75 ± 0.48 months after RME. Follow-up radiographic evaluations of 17 expansion cases were also performed after an average of 29.25 ± 1.85 months. Independent and paired t-tests were conducted to evaluate changes in tongue posture within and between groups. Results: Results revealed significant reductions of tongue-to-palate (P < .05) as well as hyoid bone-to-mandibular plane (P < .01) distances following RME. The new tongue posture was found to be stable during the follow-up period. Conclusions: A higher tongue posture can be obtained with RME in children with no reported respiratory disturbances. (Angle Orthod. 2009:79; )

Background: The purpose of this study was to investigate the relationship between soft-tissue and underlying skeletal structures before and after unilateral mandibular distraction osteogenesis. Methods: The sample consisted of 11 patients (three girls and eight boys) with an average age of 4.6 years at the time of treatment. All patients had unilateral craniofacial microsomia (four right-sided and seven left-sided unilateral craniofacial microsomia) and all underwent unilateral mandibular distraction osteogenesis. Measurements were performed on frontal medical photographs and posteroanterior cephalograms at predistraction (time 1) and postdistraction (time 2) periods. Left and right ramus heights, skeletal midline deviation, and transverse occlusal plane were measured on the posteroanterior cephalograms and compared with the linear distances between the lip commissures and the orbital plane, the circumference of both sides of the faces, and the angulation of the oral commissure plane as recorded on the medical photographs, respectively. To reduce magnification error, ratios of affected to less affected sides of the mandibles and soft-tissue facial structures were selected and studied. Results: A similar relationship was observed between soft-tissue and skeletal components. However, there was no 1:1 relationship between the changes in ramus height and improvement in parallelism of lip commissures to the orbital plane. Conclusions: A significant improvement in soft- and hard-tissue anatomy has been observed following unilateral distraction osteogenesis of the mandible. The relationship between the soft-tissue and skeletal correction was different for all patients because of the large range in severity of the craniofacial malformation. Greater skeletal deficiency requires more correction to achieve symmetry of both hard and soft tissue.