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When planning orthognathic surgery for patients with a mild Class III skeletal relationship, it may be challenging for orthodontists to predict soft tissue changes in a way that is meaningful to patients. A simple tip is to place two damp cotton wool rolls under the patient's upper lip to mimic anterior repositioning of the maxilla. While dermal fillers are becoming increasingly popular, they can complicate facial assessment as a result of the altered soft tissue profile. Patients should be encouraged not to use dermal fillers at any point along the orthognathic pathway, or delay facial assessment in multidisciplinary clinics until these fillers have dissolved.
CPD/Clinical relevance: This article describes a quick and easy chairside aid to help patients and clinicians visualise the facial changes with maxillary advancement surgery by placing two damp cotton wool rolls under the upper lip to mimic anterior repositioning of the maxilla.
There are a variety of different facial assessments (clinical and cephalometric, hard and soft tissue) that can be conducted to help plan orthognathic surgery. However, in mild skeletal Class III cases, it can be challenging for patients and clinicians to assess whether the patient would benefit from maxillary advancement only, compared to a bimaxillary procedure. An additional challenge lies in our ability, or lack thereof, to forecast the soft tissue changes in a way that is meaningful to patients.
The procedure presented is a quick and easy chairside aid which can help patients and clinicians to visualise the facial changes with maxillary advancement surgery. It involves placing two damp cotton wool rolls under the upper lip to mimic anterior repositioning of the maxilla.
Clear clinical photographs should be taken before and after placement of the cotton wool rolls so the patient can see the difference between the images. This can help in shared decision-making, whereby patients are given the opportunity to reflect on this altered facial appearance.
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