Orthognathic Surgery and Rhinoplasty: Simultaneous or Staged?

Overview

Moving the upper jaw changes the base of the nose, so jaw surgery sometimes requires nose surgery as well. This review of a 3-year case series examined which patients needed added rhinoplasty and whether it should be done at the same time or later, then proposed an algorithm.

Sections of note

• Over 589 patients were reviewed; 163 met inclusion criteria. Mean age 23.3 years.
• Three-dimensional images were used to quantify anatomical variables.
• 41.7 percent of orthognathic cases underwent adjunctive rhinoplasty.
• Of those, 82.4 percent were staged and 17.6 percent simultaneous; average time between staged procedures was 208 days.
• Among simultaneous cases, 16.7 percent had significant maxillary movement, defined as advancement over 4 to 5 mm, impaction over 2 mm, or alar base excision.
• Among staged cases, 92.9 percent had significant maxillary movement, p below 0.0001.
• All patients reported satisfaction with functional and aesthetic results during follow-up.
• The authors propose an algorithm covering orthognathic surgery alone, combined with rhinoplasty, or followed by staged rhinoplasty.

What it means for a patient

• Roughly 4 in 10 jaw surgery patients here also needed nose surgery.
• When the jaw is moved a large distance, the nose was almost always addressed later rather than at the same time, so the changed foundation can settle first.
• The average gap between the two operations was about 7 months.
• Limits: retrospective, one practice, no comparison of outcomes between the staged and simultaneous approaches, and satisfaction was self-reported without a stated instrument.

Why this paper matters

The nose and jaw are treated by different specialties, and sequencing decisions are often made ad hoc. This quantifies the pattern and links timing to how far the jaw was moved. It does not show that staging produces better results, only that it was chosen more often for larger movements.

Terms

• Orthognathic surgery: Surgery repositioning the jaw bones.
• Maxilla: The upper jaw bone, which forms the floor of the nose.
• Advancement: Moving a bone forward.
• Impaction: Moving a bone upward, shortening facial height.
• Staged: Done as a separate later operation rather than at the same sitting.