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Rhinoplasty Affects Maxillary Tooth Show
David E. Kurlander, MD
Hongyang Pi, BS
Bahman Guyuron, MD
Case Western Reserve University
2016-01-31
Presenter: David E. Kurlander, MD
Affidavit:
The majority of this project represents the original work of the resident.
Director Name: Hooman Soltanian
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics
Background: Some rhinoplasty maneuvers may influence the smile and upper incisor show. This study investigates the effects of rhinoplasty maneuvers on smile.
Methods: One hundred charts were reviewed in reverse-chronologic order. Inclusion criteria were receiving one of the ten rhinoplasty techniques of interest, preoperative and at least 6 month follow-up photographs, and matching preoperative and postoperative maximum smile extent. Maxillary tooth show was measured from the upper lip's inferior border and to the maxillary central incisors' inferior border. Preoperative and postoperative maxillary tooth show was compared by rhinoplasty technique, open versus closed approach, and extent of manipulation (resection, release, or neither) of the depressor septi nasi muscles.
Results: Sixty-one females and fifteen males with mean age of 39 were included. Maxillary tooth show reduction was observed following columella strut, alar base resection, extended spreader graft, and footplate approximation (p<0.05). No change in maxillary tooth show was seen after nasal spine graft, maxillary augmentation, tip rotation suture, shield graft, columella retraction or suspension suture (p>0.05). Open and closed approaches were associated with reduced maxillary tooth show (p<0.05). Patients undergoing release of depressor septi nasi muscles showed statistically significant reduction in maxillary tooth show (p<0.05), while patients whose depressor septi nasi muscles remained intact did not show reduction in maxillary tooth show (p>0.05).
Conclusion: Certain nasal base techniques may result in reduced maxillary tooth show, particularly when depressor septi nasi muscles are involved. This could benefit patients with a gummy smile and have an adverse effect on patients with inadequate incisor show.
