Q: Dr. Eppley, Have you ever heard of ANS reduction in conjunction with Maxillary advancement (i.e. jaw surgery). My surgeon is proposing this but has been vague about the aesthetic and functional effects. From what I have read, it makes the nasolabial angle more obtuse. Would this mean removing the ANS results in longer upper lip and turned up nose? He is also advancing the upper jaw 3.5mm and rotating it ccw 3mm. Finally, would removing ANS during surgery preclude me from a future nose job should I need one? Thank you!
A: I not only have heard of ANS reduction with LeFort osteotomies but have done that many times in conjunction with them. The reason ANS reduction may be done in large maxillary advancements is that it may cause the tip of the nose to rotate upward or, at the least, widely open up the nasolabial angle. Removing it would prevent that concern. Whether removing the ANS is necessary in just a 4mm maxillary advancement, however, is different as it may not really be needed if the total bony movement is simple forward. But if there is any upward rotation of the upper jaw it would be needed. I would trust your surgeon in that decision. But whether it is removed or not, it does not preclude or maake difficult any future rhinoplasty efforts.
Dr. Barry Eppley