Naso Labial Angle - Diagnostic Esthetic Parameter?

Orthodontic clinical diagnosis demands a decision if the treatment plan for each patient is one with therapeutic extractions or by non extraction. There are various diagnostic parameters and an important soft tissue parameter is the nasolabial angle which is formed by the tangent to the lower border of nose and upper lip and is considered a dependable representative of the soft tissue profile and clinical and cephalometric parameter to establish the treatment goals. With the current day dictum towards non extraction treatment philosophy and a preference for fuller profiles it is thought provoking to understand how sensitized to the nasolabial angle would the general practioner and plastic surgeons be as compared to the orthodontists.

The objective of this study is to determine the effect of inclination of nose and upper lip on naso labial angle and the esthetic perception of specialist and general practitioners to advice for or against need for orthodontic extractions to achieve favourable soft tissue outcomes.

Profile photograph of a patient with pleasing soft tissue profile was taken and altered using Adobe Photoshop CS, a series of photographs were developed by changing the inclination of nose and upper lip by 5 degrees progressively upto 15 degrees. A panel of judges were selected which included ten orthodontists, ten general practitioners and ten plastic surgeons to assess the photographs and were asked a question that in which case they would like to go for extraction or non- extraction treatment.

Orthodontist were more sensitive to the changes in nasolabial angle and they suggested extractions with acute nasolabial angle. The general practitioners were unable to advocate extraction or non extraction treatment on the basis of nasolabial angle. Plastic surgeons also suggested extractions considering the inclination of the upper lip.

Nasolabial angle is a valuable diagnostic parameter for the orthodontist. The general practitioners seemed to be not entirely sensitized to the soft tissues dictum put forth by the nasolabial angle. The plastic surgeons had an eye for treatment by surgical modes and their focus of interest lay primarily on the nasal architecture.