Impact of Le-Fort I osteotomy on anatomical and functional aspects of the nasal airway and on quality of life

  • Karim Zaoui
  • Reinald Kuehle
  • Ingo Baumann
  • Dorothee Laura Schuessler
  • Oliver Ristow
  • Michaela Plath
  • Christian Freudlsperger



Orthognathic surgery is a well-established procedure for skeletal deformities. Beneficial influences to the posterior airway space (PAS) have been described, but little is known about the subjective aesthetical and functional nasal aspects after orthognathic surgery. The aim of this study was to evaluate nasal airflow by anterior rhinomanometry and volumetric changes in the nasal airway space after mono- or bimaxillary surgery using cone-beam computed tomography (CBCT) and a new segmentation software. Furthermore, changes of patient’s quality of life (QoL) should be assessed.


Ten patients (9 skeletal class malformation III, 1 skeletal class malformation I) were included. CBCT images, rhinological inspections and anterior rhinomanometries were performed before (T0) and after surgery (T1). All patients completed the FROI-17, the ROE and the SF-36 questionnaires.


A significant postoperative gain for nasal airway volume compared with the baseline was shown (p < 0.014). No statistically significant differences between pre- and postoperative flow rates were found (p = 0.114). Pre- and postoperative cohorts did not differ in responses of disease-specific (ROE and FROI-17) and generic QoL questionnaires (SF-36).


Maxillary relocation surgery leads to a significant increase in nasal airway space. Subjectively, orthognathic patients did not experience any functional but psychosocial aspects after bimaxillary surgery.


Le Fort-I-osteotomy Nasal airway space Orthognathic surgery Rhinomanometry Quality of life 


Author contributions

All authors made substantial contributions to the study and have approved the final article. 
MP: designed and coordinated the study, participated in data acquisition and analysis, interpreted the data and drafted the manuscript. RK: participated in data acquisition and analysis, coordinated the study and critically revised the manuscript for important intellectual content. IB: participated in data interpretation and revision of the manuscript. DLS: participated in data interpretation and revision of the manuscript. OR: participated in data interpretation and revision of the manuscript. KZ: designed and coordinated the study, participated in data acquisition and analysis, critically revised the manuscript for important intellectual content. CF: designed and coordinated the study, participated in data acquisition and analysis, interpreted the data, critically revised the manuscript for important intellectual content.


No external/additional funding was received for this study.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

The Ethics Committee of the Medical Faculty at the University of Heidelberg granted permission to conduct the study (project no S-533/2017).


  1. 1.
    Erbe M, Lehotay M, Gode U, Wigand ME, Neukam FW (2001) Nasal airway changes after Le Fort I—impaction and advancement: anatomical and functional findings. Int J Oral Maxillofac Surg 30(2):123–129Google Scholar
  2. 2.
    Guenthner TA, Sather AH, Kern EB (1984) The effect of Le Fort I maxillary impaction on nasal airway resistance. Am J Orthod 85(4):308–315Google Scholar
  3. 3.
    Galbiati G, Maspero C, Giannini L, Guenza GC, Zanoni F, Farronato G (2017) Orthodontic—surgical treatment and respiratory function: rhinomanometric assessment. Minerva Stomatol 66(3):91–97Google Scholar
  4. 4.
    Posnick JC, Agnihotri N (2010) Consequences and management of nasal airway obstruction in the dentofacial deformity patient. Curr Opin Otolaryngol Head Neck Surg 18(4):323–331Google Scholar
  5. 5.
    Haarmann S, Budihardja AS, Wolff KD, Wangerin K (2009) Changes in acoustic airway profiles and nasal airway resistance after Le Fort I osteotomy and functional rhinosurgery: a prospective study. Int J Oral Maxillofac Surg 38(4):321–325Google Scholar
  6. 6.
    Gokce SM, Gorgulu S, Karacayli U, Gokce HS, Battal B (2015) Three-dimensional evaluation of nasal and pharyngeal airway after Le Fort I maxillary distraction osteogenesis. Int J Oral Maxillofac Surg 44(4):455–461Google Scholar
  7. 7.
    Harada K, Ishii Y, Ishii M, Imaizumi H, Mibu M, Omura K (2002) Effect of maxillary distraction osteogenesis on velopharyngeal function: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93(5):538–543Google Scholar
  8. 8.
    Gokce SM, Gorgulu S, Gokce HS, Bengi O, Sabuncuoglu F, Ozgen F et al (2012) Changes in posterior airway space, pulmonary function and sleep quality, following bimaxillary orthognathic surgery. Int J Oral Maxillofac Surg 41(7):820–829Google Scholar
  9. 9.
    Rustemeyer J, Martin A, Gregersen J (2012) Changes in quality of life and their relation to cephalometric changes in orthognathic surgery patients. Angle Orthod 82(2):235–241Google Scholar
  10. 10.
    Becker M, Diamond R, Sainfort F (1993) A new patient focused index for measuring quality of life in persons with severe and persistent mental illness. Qual Life Res 2(4):239–251Google Scholar
  11. 11.
    Bulut OC, Plinkert PK, Wallner F, Baumann I (2016) Quality of life in functional rhinoplasty: rhinoplasty outcomes evaluation German version (ROE-D). Eur Arch Otorhinolaryngol 273(9):2569–2573Google Scholar
  12. 12.
    Bulut C, Wallner F, Plinkert PK, Baumann I (2014) Development and validation of the Functional Rhinoplasty Outcome Inventory 17 (FROI-17). Rhinology 52(4):315–319Google Scholar
  13. 13.
    Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S et al (1999) Clinical predictors of obstructive sleep apnea. Laryngoscope 109(12):1901–1907Google Scholar
  14. 14.
    Rodrigues MM, Dibbern RS, Goulart CW, Palma RA (2010) Correlation between the Friedman classification and the Apnea-Hypopnea Index in a population with OSAHS. Braz J Otorhinolaryngol 76(5):557–560Google Scholar
  15. 15.
    Clement PA (1984) Committee report on standardization of rhinomanometry. Rhinology 22(3):151–155Google Scholar
  16. 16.
    Vogt K, Sachse D, Wernecke KD, Kriesmer T (1990) [A computer-assisted system for diagnosing rhinologic function]. HNO 38(3):110–115Google Scholar
  17. 17.
    Bockmann R, Meyns J, Dik E, Kessler P (2014) The modifications of the sagittal ramus split osteotomy: a literature review. Plast Reconstr Surg Glob Open 2(12):e271Google Scholar
  18. 18.
    Bulut OC, Wallner F, Plinkert PK, Prochnow S, Kuhnt C, Baumann I (2015) Quality of life after septorhinoplasty measured with the Functional Rhinoplasty Outcome Inventory 17 (FROI-17). Rhinology 53(1):54–58Google Scholar
  19. 19.
    Bulut OC, Wallner F, Oladokun D, Kayser C, Plath M, Schulz E et al (2018) Long-term quality of life changes after primary septorhinoplasty. Qual Life Res 27(4):987–991Google Scholar
  20. 20.
    Kochel J, Meyer-Marcotty P, Sickel F, Lindorf H, Stellzig-Eisenhauer A (2013) Short-term pharyngeal airway changes after mandibular advancement surgery in adult Class II-Patients—a three-dimensional retrospective study. J Orofac Orthop 74(2):137–152Google Scholar
  21. 21.
    Lenza MG, Lenza MM, Dalstra M, Melsen B, Cattaneo PM (2010) An analysis of different approaches to the assessment of upper airway morphology: a CBCT study. Orthod Craniofac Res 13(2):96–105Google Scholar
  22. 22.
    Ghoneima A, Kula K (2013) Accuracy and reliability of cone-beam computed tomography for airway volume analysis. Eur J Orthod 35(2):256–261Google Scholar
  23. 23.
    Ristow O, Ruckschloss T, Berger M, Grotz T, Kargus S, Krisam J et al (2018) Short- and long-term changes of the pharyngeal airway after surgical mandibular advancement in Class II patients-a three-dimensional retrospective study. J Craniomaxillofac Surg 46(1):56–62Google Scholar
  24. 24.
    Bulut OC, Wallner F, Hohenberger R, Plinkert PK, Baumann I (2017) Quality of life after primary septorhinoplasty in deviated- and non-deviated nose measured with ROE, FROI-17 and SF-36. Rhinology 55(1):75–80Google Scholar
  25. 25.
    Hill S, Harries U, Popay J (1996) Is the short form 36 (SF-36) suitable for routine health outcomes assessment in health care for older people? Evidence from preliminary work in community based health services in England. J Epidemiol Community Health 50(1):94–98Google Scholar
  26. 26.
    Hayes V, Morris J, Wolfe C, Morgan M (1995) The SF-36 health survey questionnaire: is it suitable for use with older adults? Age Ageing 24(2):120–125Google Scholar
  27. 27.
    O’Mahony PG, Rodgers H, Thomson RG, Dobson R, James OF (1998) Is the SF-36 suitable for assessing health status of older stroke patients? Age Ageing 27(1):19–22Google Scholar
  28. 28.
    Smith IE, Shneerson JM (1995) Is the SF 36 sensitive to sleep disruption? A study in subjects with sleep apnoea. J Sleep Res 4(3):183–188Google Scholar
  29. 29.
    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483Google Scholar
  30. 30.
    Cingi C, Songu M, Bal C (2011) Outcomes research in rhinoplasty: body image and quality of life. Am J Rhinol Allergy 25(4):263–267Google Scholar
  31. 31.
    Silvola AS, Varimo M, Tolvanen M, Rusanen J, Lahti S, Pirttiniemi P (2014) Dental esthetics and quality of life in adults with severe malocclusion before and after treatment. Angle Orthod 84(4):594–599Google Scholar
  32. 32.
    Forssell H, Finne K, Forssell K, Panula K, Blinnikka LM (1998) Expectations and perceptions regarding treatment: a prospective study of patients undergoing orthognathic surgery. Int J Adult Orthodon Orthognath Surg 13(2):107–113Google Scholar
  33. 33.
    Zhou YH, Hagg U, Rabie AB (2001) Patient satisfaction following orthognathic surgical correction of skeletal Class III malocclusion. Int J Adult Orthodon Orthognath Surg 16(2):99–107Google Scholar
  34. 34.
    Kiyak HA, Hohl T, West RA, McNeill RW (1984) Psychologic changes in orthognathic surgery patients: a 24-month follow up. J Oral Maxillofac Surg 42(8):506–512Google Scholar
  35. 35.
    Macgregor FC (1970) Social and psychological implications of dentofacial disfigurement. Angle Orthod 40(3):231–233Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Karim Zaoui
    • 1
  • Reinald Kuehle
    • 2
  • Ingo Baumann
    • 1
  • Dorothee Laura Schuessler
    • 3
  • Oliver Ristow
    • 2
  • Michaela Plath
    • 1
  • Christian Freudlsperger
    • 2
  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Heidelberg, Ruprecht-Karls-UniversityHeidelbergGermany
  2. 2.Department of Oral and Maxillofacial SurgeryUniversity Hospital HeidelbergHeidelbergGermany
  3. 3.Department of Restorative DentistryUniversity Hospital HeidelbergHeidelbergGermany

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