The effects of VY closure on lip morphology after Le Fort I maxillary advancement: A systematic review

VY closure of the Le Fort 1 incision may commonly be indicated to mitigate the lip shortening effects of maxillary advancement. The objective of this systematic review was to investigate if VY closure prevents lip shortening when compared with conventional continuous closure (CS) methods, in patients who underwent le fort 1 maxillary advancement. PubMed, Embase, and Cochrane Library databases were accessed. Hand searching was also performed. Observational studies, non-randomised and randomized controlled trials were included if Le Fort 1 maxillary advancement was performed to correct a dentofacial deformity. Comparisons were made between VY and CS, and morphological changes to the upper lip were evaluated. The demographic data, study methodology, magnitude of maxillary movements and outcomes related to the lip morphology (length, vermillion exposure, thickness and angulation) were extracted. The search yielded 487 articles. Six studies were included after the application of the selection criteria. A total of 100 and 94 patients received CS and VY respectively. VY was not found to reliably prevent lip shortening. VY was more likely to mitigate lip shortening when there is a large maxillary advancement. It was consistent for a protrusive or "rolled-out” lip morphology to occur after a VY closure. This was demonstrated by the increase in lip vermillion exposure, thickness, and angulation. VY closure was a useful adjunctive technique in patients undergoing large maxillary advancements to mitigate the lip shortening effect from the procedure. Surgeons who employ this technique must also be aware of the consequence of a more protrusive lip with increased vermillion exposure and assess if this would be aesthetically desirable for the individual patient.