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Revista Española de Cirugía Oral y Maxilofacial

On-line version ISSN 2173-9161Print version ISSN 1130-0558


BARREDA HALE, Mauricio et al. Clinical comparison of two external anatomical references for maxillary positioning in orthognathic surgery. Rev Esp Cirug Oral y Maxilofac [online]. 2020, vol.42, n.4, pp.158-164.  Epub Feb 01, 2021. ISSN 2173-9161.


The use of external reference points (ERP) like the nasal pin (NP) and eye's medial canthus (EMC) provides a stable and reproductible landmarks for maxillary repositioning. ERP are widely used, for its practicality to achieve the desired aesthetic result in orthognathic surgery (OS).


The purpose of this study is to compare the ERPs: NP and EMC, to define which is the most accurate, and also define its limitations, in the intraoperative phase for vertical repositioning of the maxilla.

Patients and methods:

We performed a retrospective study on 26 patients who underwent OS from December 2015 to August 2018. Previous to the Le Fort I osteotomy, the vertical measurements were made. The most accurate ERP was considered to be the one that obtained the least average difference between the vertical measurement of the pre-surgical planning and that obtained in the intraoperative period.


The planned vertical movement was an average of -1.73 mm ± 1.97 SD, with the largest maxillary impaction movement of -6 mm and the largest maxillary descent of 2 mm. The difference between planned vertical movement and obtained measurements of vertical change for NP had an average 0.05 mm ± 0.51 SD (95 % CI, -0.15 - 0.26), and the difference between planned vertical movement and obtained measurements for EMC had an average 1.23 mm ± 1.29 SD (95 % CI, 0.71 - 1.75), with a statistically significant difference (p = 0.0001) between them of -1.18 mm± 1.23 (95 % CI, -1.67 - -0.68).


The use of the NP as an ERP provides greater precision and predictability of movement in the vertical repositioning of the maxillomandibular-complex, compared to the use of EMC. Both techniques can be used as a complement, being aware of the effect of triangulation.

Keywords : Facial asymmetry; Le Fort osteotomy; maxillary osteotomy; medial canthus; nasal pin; orthognathic surgery..

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