Alterations of the Maxillary Sinus After Orthognathic Surgery: A Systematic Review

Abstract

This study aimed to evaluate the effects of Le Fort I osteotomy, a common procedure in orthognathic surgery, on maxillary sinus volume. The methodology employed was a systematic review, following PRISMA 2020 guidelines, which included seven studies published between 2013 and 2024. The analyzed studies evaluated patients who underwent Le Fort I osteotomy, either isolated or as part of bimaxillary surgery, using computed tomography (CT or CBCT) for sinus volume measurement. The results showed a consistent and significant volumetric reduction of the maxillary sinus in all seven studies after surgery, with the magnitude of the reduction being more pronounced in cases of complex maxillary movements, such as impaction and rotation, reaching up to 22.6%. In addition to volume reduction, secondary morphological changes were observed, such as increased sinus mucosal thickness and modifications to the maxillary ostium, including displacement and narrowing. Due to the high clinical and methodological heterogeneity of the studies, a statistical meta-analysis was not possible, and the overall risk of bias was classified as moderate in most cases. It is concluded that Le Fort I osteotomy is consistently associated with a significant reduction in maxillary sinus volume and morphological changes that may have clinical implications for sinus function, such as drainage and ventilation. The findings suggest the need for caution in surgical planning and postoperative monitoring in at-risk patients, and indicate that future research should focus on prospective and standardized studies to correlate volumetric changes with clinical outcomes.

Keywords: Orthognathic Surgery; Maxillary Sinus; Le Fort Osteotomy; Volume; Systematic Review; Computed Tomography.