{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T12:30:28Z","timestamp":1792931428097,"version":"4.5.0"},"reference-count":44,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,1,18]],"date-time":"2020-01-18T00:00:00Z","timestamp":1579305600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004606","name":"Chang Gung Medical Foundation","doi-asserted-by":"publisher","award":["CMRPG3J0601"],"award-info":[{"award-number":["CMRPG3J0601"]}],"id":[{"id":"10.13039\/501100004606","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Patients with a skeletal Class III deformity may present with a concave contour of the anteromedial cheek region. Le Fort I maxillary advancement and rotational movements correct the problem but information on the impact on the anteromedial cheek soft tissue change has been insufficient to date. This three-dimensional (3D) imaging-assisted study assessed the effect of surgical maxillary advancement and clockwise rotational movements on the anteromedial cheek soft tissue change. Two-week preoperative and 6-month postoperative cone-beam computed tomography scans were obtained from 48 consecutive patients who received 3D-guided two-jaw orthognathic surgery for the correction of Class III malocclusion associated with a midface deficiency and concave facial profile. Postoperative 3D facial bone and soft tissue models were superimposed on the corresponding preoperative models. The region of interest at the anteromedial cheek area was defined. The 3D cheek volumetric change (mm3; postoperative minus preoperative models) and the preoperative surface area (mm2) were computed to estimate the average sagittal movement (mm). The 3D cheek mass position from orthognathic surgery-treated patients was compared with published 3D normative data. Surgical maxillary advancement (all p &lt; 0.001) and maxillary rotation (all p &lt; 0.006) had a significant effect on the 3D anteromedial cheek soft tissue change. In total, 78.9%, 78.8%, and 78.8% of the variation in the cheek soft tissue sagittal movement was explained by the variation in the maxillary advancement and rotation movements for the right, left, and total cheek regions, respectively. The multiple linear regression models defined ratio values (relationship) between the 3D cheek soft tissue sagittal movement and maxillary bone advancement and rotational movements of 0.627 and 0.070, respectively. Maxillary advancements of 3\u20134 mm and &gt;4 mm resulted in a 3D cheek mass position (1.91 \u00b1 0.53 mm and 2.36 \u00b1 0.72 mm, respectively) similar (all p &gt; 0.05) to the 3D norm value (2.15 \u00b1 1.2 mm). This study showed that both Le Fort I maxillary advancement and rotational movements affect the anteromedial cheek soft tissue change, with the maxillary advancement movement presenting a larger effect on the cheek soft tissue movement than the maxillary rotational movement. These findings can be applied in future multidisciplinary-based decision-making processes for planning and executing orthognathic surgery.<\/jats:p>","DOI":"10.3390\/jcm9010262","type":"journal-article","created":{"date-parts":[[2020,1,21]],"date-time":"2020-01-21T03:04:43Z","timestamp":1579575883000},"page":"262","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Effect of Le Fort I Maxillary Advancement and Clockwise Rotation on the Anteromedial Cheek Soft Tissue Change in Patients with Skeletal Class III Pattern and Midface Deficiency: A 3D Imaging-Based Prediction Study"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6531-0670","authenticated-orcid":false,"given":"Hsin-Chih","family":"Lai","sequence":"first","affiliation":[{"name":"Division of Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0525-3480","authenticated-orcid":false,"given":"Rafael","family":"Denadai","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Ting","family":"Ho","sequence":"additional","affiliation":[{"name":"Division of Orthodontics, Department of Dentistry, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiu-Hsia","family":"Lin","sequence":"additional","affiliation":[{"name":"Image Lab and Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lun-Jou","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,1,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s002669900295","article-title":"Changes in ocular globe-to-orbital rim position with age: Implications for aesthetic blepharoplasty of the lower eyelids","volume":"23","author":"Pessa","year":"1999","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1093\/asj\/sjx122","article-title":"Quantification of the aesthetically desirable female midface position","volume":"38","author":"Linkov","year":"2018","journal-title":"Aesthet. Surg. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"818e","DOI":"10.1097\/PRS.0000000000001226","article-title":"Pertinent anatomy and analysis for midface volumizing procedures","volume":"135","author":"Surek","year":"2015","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1097\/00006534-200105000-00047","article-title":"Infraorbital rim augmentation","volume":"107","author":"Yaremchuk","year":"2001","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"790","DOI":"10.2319\/111612-881.1","article-title":"New diagnostic tenet of the esthetic midface for clinical assessment of anterior malar projection","volume":"83","author":"Frey","year":"2013","journal-title":"Angle Orthod."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Ho, C.T., Denadai, R., Lai, H.C., Lo, L.J., and Lin, H.H. (2019). Computer-aided planning in orthognathic surgery: A comparative study with the establishment of burstone analysis-derived 3D norms. J. Clin. Med., 8.","DOI":"10.3390\/jcm8122106"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1097\/00006534-199604000-00002","article-title":"The concept of the sagittal orbital-globe relationship in craniofacial surgery","volume":"97","author":"Mulliken","year":"1996","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1097\/01.prs.0000297836.98360.8a","article-title":"Midface augmentation using bony segments obtained from sagittal splitting angle ostectomy in Asians","volume":"121","author":"Park","year":"2008","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1016\/j.ijom.2017.04.009","article-title":"Augmentation of the infraorbital rim in orthognathic surgery","volume":"46","author":"Fattahi","year":"2017","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s10006-008-0094-8","article-title":"Three-dimensional analysis of changes of the malar-midfacial region after LeFort I osteotomy and maxillary advancement","volume":"12","author":"Nkenke","year":"2008","journal-title":"Oral. Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1097\/00006534-198709000-00001","article-title":"Aesthetic augmentation of the malar-midface structures","volume":"80","author":"Whitaker","year":"1987","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/0278-2391(90)90171-W","article-title":"Quadrangular Le Fort I osteotomy: Surgical technique and review of 54 patients","volume":"48","author":"Keller","year":"1990","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1097\/SCS.0b013e31828010a9","article-title":"Three-dimensional analysis of soft tissue changes in fullface view after surgical correction of skeletal class III malocclusion","volume":"24","author":"Yuan","year":"2013","journal-title":"J. Craniofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e225","DOI":"10.1016\/j.joms.2010.12.035","article-title":"Midfacial soft-tissue changes after advancement of maxilla with Le Fort I osteotomy and mandibular setback surgery: Comparison of conventional and high Le Fort I osteotomies by superimposition of cone-beam computed tomography volumes","volume":"69","author":"Kim","year":"2011","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.tripleo.2008.12.026","article-title":"Hard and soft tissue changes after correction of mandibular prognathism and facial asymmetry by mandibular setback surgery: Three-dimensional analysis using computerized tomography","volume":"107","author":"Jung","year":"2009","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.jcms.2012.05.017","article-title":"Midfacial soft-tissue changes after mandibular setback surgery with or without paranasal augmentation: Cone-beam computed tomography (CBCT) volume superimposition","volume":"41","author":"Park","year":"2013","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e20","DOI":"10.1016\/j.tripleo.2010.01.002","article-title":"Three-dimensional evaluation of soft tissue changes after mandibular setback surgery in class III malocclusion patients according to extent of mandibular setback, vertical skeletal pattern, and genioplasty","volume":"109","author":"Kim","year":"2010","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.ijom.2013.07.738","article-title":"Aesthetic and functional implications following rotation of the maxillomandibular complex in orthognathic surgery: A systematic review","volume":"43","author":"Sonego","year":"2014","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.jcms.2013.05.004","article-title":"Frontal soft tissue analysis using a 3 dimensional camera following two-jaw rotational orthognathic surgery in skeletal class III patients","volume":"42","author":"Choi","year":"2014","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1097\/SCS.0000000000003754","article-title":"Three-dimensional analysis of midfacial soft tissue changes after maxillary posterior impaction and intraoral vertical ramus osteotomy for mandibular setback in class III Patients","volume":"28","author":"Seo","year":"2017","journal-title":"J. Craniofac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.ajodo.2010.02.022","article-title":"Facial soft-tissue changes in skeletal class III orthognathic surgery patients analyzed with 3-dimensional laser scanning","volume":"138","author":"Baik","year":"2010","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1016\/j.joms.2017.05.010","article-title":"Soft tissue changes measured with three-dimensional software provides new insights for surgical predictions","volume":"75","author":"Chang","year":"2017","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"143","DOI":"10.4041\/kjod.2018.48.3.143","article-title":"Hard- and soft-tissue profiles of the midface region in patients with skeletal class III malocclusion using cone-beam computed tomography multiplanar-reconstructed image analysis","volume":"48","author":"Kim","year":"2018","journal-title":"Korean J. Orthod."},{"key":"ref_24","unstructured":"Willinger, K., Cede, J., Guevara-Rojas, G., Sinko, K., Figl, M., Schicho, K., Nemec, S., and Klug, C. (2019). Midfacial advancement line\u2014A comparative evaluation of a new measurement method in orthognathic surgery. J. Oral. Maxillofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.joms.2017.07.158","article-title":"Soft tissue changes in patients undergoing intraoral quadrangular Le Fort II osteotomy versus conventional Le Fort I osteotomy","volume":"76","author":"Wagner","year":"2018","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Lo, L.J., Weng, J.L., Ho, C.T., and Lin, H.H. (2018). Three-dimensional region-based study on the relationship between soft and hard tissue changes after orthognathic surgery in patients with prognathism. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0200589"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.bjps.2017.04.012","article-title":"Postoperative outcomes of two- and three-dimensional planning in orthognathic surgery: A comparative study","volume":"70","author":"Wu","year":"2017","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lin, H.H., Chuang, Y.F., Weng, J.L., and Lo, L.J. (2015). Comparative validity and reproducibility study of various landmark-oriented reference planes in 3-dimensional computed tomographic analysis for patients receiving orthognathic surgery. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0117604"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"40423","DOI":"10.1038\/srep40423","article-title":"Three-dimensional surgical simulation improves the planning for correction of facial prognathism and asymmetry: A qualitative and quantitative study","volume":"7","author":"Ho","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1027e","DOI":"10.1097\/PRS.0000000000005556","article-title":"Intraoral scanning and setting up the digital final occlusion in three-dimensional planning of orthognathic surgery: Its comparison with the dental model approach","volume":"143","author":"Ho","year":"2019","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Seo, H.J., Denadai, R., Pai, B.C.J., and Lo, L.J. (2019). Modern surgery-first approach concept in cleft-orthognathic surgery: A comparative cohort study with 3D quantitative analysis of surgical-occlusion setup. J. Clin. Med., 8.","DOI":"10.3390\/jcm8122116"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Denadai, R., Chou, P.Y., Su, Y.Y., Lo, C.C., Lin, H.H., Ho, C.T., and Lo, L.J. (2019). Facial appearance and psychosocial features in orthognathic surgery: A FACE-Q- and 3D facial image-based comparative study of patient-, clinician-, and lay-observer-reported outcomes. J. Clin. Med., 8.","DOI":"10.3390\/jcm8060909"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"13337","DOI":"10.1038\/s41598-019-49946-9","article-title":"The outcome of skeletofacial reconstruction with mandibular rotation for management of asymmetric skeletal class III deformity: A three-dimensional computer-assisted investigation","volume":"9","author":"Wu","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Seo, H.J., Denadai, R., Pai, B.C.J., and Lo, L.J. (2019). Digital occlusion setup is quantitatively comparable to the conventional dental model approach: Characteristics and guidelines for orthognathic surgery in patients with unilateral cleft lip and palate. Ann. Plast. Surg.","DOI":"10.1097\/SAP.0000000000002079"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.1097\/SAP.0000000000001008","article-title":"Higher dose of dexamethasone does not further reduce facial swelling after orthognathic surgery: A randomized controlled trial using 3-Dimensional photogrammetry","volume":"78","author":"Lin","year":"2017","journal-title":"Ann. Plast. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/j.1601-6343.2006.00341.x","article-title":"A new method for the 3D measurement of postoperative swelling following orthognathic surgery","volume":"9","author":"Kau","year":"2006","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Altman, D.G. (1990). Practical Statistics for Medical Research, Chapman & Hall\/CRC. [1st ed.].","DOI":"10.1201\/9780429258589"},{"key":"ref_38","unstructured":"Hinkle, D.E., Wiersma, W., and Jurs, S.G. (2003). Applied Statistics for the Behavioral Sciences, Houghton Mifflin. [5th ed.]."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Beebee, H., Hitchcock, C., and Menzies, P. (2009). The Oxford Handbook of Causation, Oxford University Press.","DOI":"10.1093\/oxfordhb\/9780199279739.001.0001"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Su, Y.Y., Denadai, R., Ho, C.T., Lai, B.R., and Lo, L.J. (2019). Measuring patient-reported outcomes in orthognathic surgery: Linguistic and psychometric validation of the Mandarin Chinese version of FACE-Q. Biomed. J.","DOI":"10.1016\/j.bj.2019.05.011"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Denadai, R., Chou, P.Y., Su, Y.Y., Lin, H.H., Ho, C.T., and Lo, L.J. (2019). The impacts of orthognathic surgery on the facial appearance and age perception of patients presenting skeletal class III deformity: An outcome study using the FACE-Q report and surgical professional-based panel assessment. Plast. Reconstr. Surg., (accepted).","DOI":"10.1097\/PRS.0000000000006650"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1097\/SCS.0000000000000620","article-title":"Correlation analysis of three-dimensional changes of hard and soft tissues in class III orthognathic surgery patients using cone-beam computed tomography","volume":"25","author":"Lee","year":"2014","journal-title":"J. Craniofac. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/S0889-5406(94)70002-8","article-title":"A three-dimensional soft tissue analysis of fifteen patients with class, II; Division 1 malocclusions after bimaxillary surgery","volume":"105","author":"Moss","year":"1994","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/j.joms.2004.04.019","article-title":"Evaluation of facial soft tissue changes with optical surface scan after surgical correction of class III deformities","volume":"62","author":"Soncul","year":"2004","journal-title":"J. Oral. Maxillofac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/1\/262\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:43:57Z","timestamp":1760363037000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/1\/262"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,18]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,1]]}},"alternative-id":["jcm9010262"],"URL":"https:\/\/doi.org\/10.3390\/jcm9010262","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,18]]}}}