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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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Exclusion criteria were cleft lip, previous nasal operation, and previous or simultaneous additional midfacial operations. The range in both groups was large, indicating great individual variability. They also suggested that a modified cinch suture may result in greater stability. Group 2 showed a near pre-operative alar position compared to group 1. In the cnch region the suthre line should not be placed too high in order not to lose the bone contact and to avoid entrance into a low piriform aperture.

The width of the alar base was measured before operation, and then at one, and six months.

Nasal widening is commonly associated to maxillary osteotomies, but it is only partially dependent on the amount of skeletal movement. Cinch suture as an adjuvant procedure does not eliminate post-operative alar flare completely because it does not address the other contributing factors like the loss of pyriform depth and septal resection, which needs further evaluation.

Intergroup comparison was done by independent sample t test and it pronounced the following results: Changes to the nose clearly occur after Le Fort 1 osteotomy superior repositioning.

Cinh suture is tied only if the cinching effect is adequate; otherwise, the maneuver has to be repeated. As soon as the correct plane is reached, the dissection is continued bluntly. Hari Kishore Bhat, Email: Mean and standard deviation of pre—post operative cijch in groups 1 and 2 aalr Paired sample t test in groups 1 and 2 to determine p value. A suture is passed through the insertion area of the labial muscles.

We believe that the strength of our modified technique is based on its simplicity and consistency; the midline knot anchored to the hole in the nasal spine allows a more symmetric result and avoids the problem of an infection or a foreign body reaction in the skin.

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 ]. This adds to the alsr of the study. During Le Fort 1 osteotomy with superior repositioning of the maxilla, we observed that there was a reduction in the depth of the nasal aperture. Lip—nasal aesthetics following Clnch Fort I osteotomy. Thirty-two patients with skeletal class III facial deformity who had orthognathic operations by the same surgeon were recruited in this study.

The free ends of the sutures are tied into a firm knot against the forcep that hold them together.

Use of the alar base cinch suture in Le Fort I osteotomy: is it effective?

The suture did not significantly influence nasal sutuer projection. Indeed, periosteal elevation disinserts the facial muscles from the naso-labial area and the anterior nasal spine.

When the loop is tightened the alar bases are pulled medially. Eur J Plast Surg.

Use of the alar base cinch suture in Le Fort I osteotomy: is it effective?

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.

Techniques for controlling lateralization of the ala, including the alar base cinch technique, originally described by Millard, have been well reported by Collins and Epker and later modified by others. The vestibular mucosa is advanced with a skin hook in the midline to pull the soft-tissue envelope anteriorly. Nasal changes after surgical correction of skeletal correction of skeletal Class III malocclusion in Koreans.

Compliance with Ethical Standards Conflict of interest None.

Since this part of the dissection is done without visual control, the tip of the periosteal elevator is always kept in intimate contact with the bony surface. Efficacy and stability of the alar base cinch suture.

Conclusion Cunch conclude that Le Fort 1 osteotomy superior repositioning leads to a widening of alar region of the nose, especially the alar base.

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.

In the sample, there were 13 men and 19 women, average age There were no major or minor complications. A cindh stick shaped incision with alat vertical vestibular extension at the dorsal ends A has the advantage of being easily extendible onto the zygomatic prominence, while the risk of uncontrolled tearing of the mucosa during retraction is reduced in contrast to a horizontal posterior cut B. The article is distributed under the Creative Commons Attribution License, which permits unrestricted syture, distribution, and reproduction in any medium, provided the original work is properly cited.

An Alternative Alar Cinch Suture

The amount of subperiosteal dissection performed, which involves the allar surface of the maxilla, seems to play a major role. The same procedure is done through the skin point at the other side of the nose. Open in a separate window. Contact Disclaimer AO Foundation. Please review our privacy policy.

Results Group alwr showed a near pre-operative alar position compared to group 1. This modification is interesting but shows some pitfalls.

Distance measured between the center of the alar bases using vernier caliper.