A modified alar cinch suture technique. Article (PDF Available) in European Journal of Plastic Surgery 32(6) · December with. Next, small amounts of the solution are injected beneath the alar bases and the nasolabial To control the width of the alar base, an alar cinch suture is used. Secondary changes of the nasolabial region after the Le Fort I osteotomy procedure are well known and include widening of the alar base of the nose, upturning.
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Alar cinching through the vestibular incision used for maxillary osteotomy seems to aar a simple and convenient way of narrow the alar base. A modified alar cinch suture technique.
The sutures are cut short, the forcep is released, and the knot can dig into the tissue channel made by the needle. Materials and Methods Inclusion Criteria Patients diagnosed with the following conditions: Nasal anatomy and maxillary surgery. A line of a local anesthetic mixed with epinephrine 1: The knot is based on the edge of the anterior nasal spine ANS bringing the naso-labial muscles closer to the nasal spine.
Use of the alar base cinch suture in Le Fort I osteotomy: is it effective?
Finally, a skin infection on the site where the knot submerges under the skin may develop. Support Center Support Center.
The technique for controlling lateralization of the ala, including the alar sutre cinch technique, was originally described by Millard 6 to correct nasal defects in patients with cleft lip, then described by Collins and Epker 7 for its use in suturr patients, and later modified by others.
Recently a number of studies have looked at the stability and clinical outcome of this intervention. Fifteen patients were subjected to endonasal intubation and underwent Le Fort 1 osteotomy with superior repositioning combined with cinch suturing.
During wound closure, however, the tissue outstretches and can be easily grasped. Results Group 2 showed a near pre-operative alar position compared to group 1.
The alar base cinch suture is often used to mitigate the unfavourable increase in nasal width after Le Fort I impaction or advancement of the maxilla. The alar flare resulting from every millimeter of impaction was significantly less in group 2 compared to group 1.
An Alternative Alar Cinch Suture
The results from group 2 indicate that the amount of nasal flare was dictated by the kind of adjunctive procedure and not by the amount of maxillary intrusion carried out. Tension is applied to the sutures with the needle hub pressed against the alar base and the skin, thus resulting in narrowing of the alar width. General consideration The maxillary vestibular approach is simple and safe, as long as allar dissection proceeds strictly in the subperiosteal plane.
The suture is pulled back and forth several times until it is embedded under the skin into the dermis to prevent an unsightly dimple. Discussion Many studies have reported secondary morphological changes in the nose, including alar flaring after a Le Fort 1 osteotomy. Open in a separate window. However, the alar flare, resulting as a consequence of superior repositioning of the maxilla, mars the objective of correcting VME and gummy smile. The suture did reduce alar flaring but it also increased the naso-labial angle.
We investigated the effect of an alar base cinch suture on the change in width of the alar base after Le Fort I osteotomy using a three-dimensional imaging system. A more effective alar cinch technique. The needle is then pulled out together with the artery forcep that holds the sutures until the blunt end of the needle is seen.
We also noticed cinch suturing was effective in mitigating the alar flare increase following the intrusion. The range in both groups was large, indicating great individual variability. Psychological aspects of orthognathic cincg J Maxillofac Oral Surg.
In our study the Regression analysis clearly suggested that the there is a significant reduction in the alar flare in group 2 compared to group 1.
Conclusion We conclude that Le Fort 1 osteotomy superior repositioning leads to a widening sutuge alar region of the nose, especially the alar base. In the edentulous maxilla, where the alveolar crest and the nasal floor converge due to progressive bone atrophy, the incision should be placed shture the base of the alveolar crest.
The use of cincy intubation facilitated accurate measurement of the changes in nasal width produced by the osteotomy and the cinch suture. The anterior nasal spine and the lower border of the cartilaginous septum are addressed by soft-tissue retraction with a forked angle retractor and the perichondrium on top of the cartilaginous septal border is incised.
Tip sufure and maxillary advancement: The dissection may move on superiorly to the infraorbital rim. Nasal deformities associated with orthognathic surgery: This adds to the significance of the study. The mean value of both the measurements was taken as pre-op interalar width. Introduction Le Fort 1 intrusion osteotomies are known to cause adverse effects on the oro-facial soft tissues such as broadening of the alar base, loss of vermillion show of the upper lip and down sloping of the commissure [ 1 ].
There are various adjunctive procedures but no evidence to suggest the efficacy of each adjunctive procedure advocated to minimize nasal changes. Beginning posteriorly, sutures are placed through sutude, submucosa, musculature, and periosteum in a staggered fashion bringing the upper vestibular mucosa in an anterior position along a rotational arch. To prospectively analyze the amount of alar flare, factors contributing to alar flare and efficacy of cinch suture as an adjunctive procedure for alar flare reduction.
Nasal widening is commonly associated to maxillary osteotomies, but it is only partially dependent on the amount of skeletal movement. Finally, the needle is retracted from the skin leaving the suture through the soft tissues. Conclusion Alar cinch suture restores the normal alar width by preventing the lateral drift of the naso-labial muscle and thereby reducing the postoperative nasal flare significantly.
We think that the procedure performed postoperatively creates a lot of discomfort for the patients; asymmetry due to the knot performed on a side of the nose and not in the midline may result. The base of the nose was marked with 3 landmarks: Excessive widening and superior retraction result in an ugly deepening of the alar-cheek groove, making the patient look older.
Intergroup comparison was done by independent sample t test and it pronounced the following results: