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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Author information Article notes Copyright and License information Disclaimer. Following this method, the nasal mucosa can be stripped successively. General consideration The maxillary vestibular approach is simple and safe, as long as the dissection proceeds strictly in the subperiosteal plane. However, the alar flare, duture as a consequence of superior repositioning of the maxilla, mars the objective of correcting VME and gummy smile.
A dissection extending onto the anterior zygomatic arch necessitates sharp transsection of the ccinch masseter muscle attachments. The first forcep is then removed together with the needle. The alar base cinch: There are various adjunctive procedures but no evidence to suggest the efficacy of each adjunctive procedure advocated to minimize nasal changes.
According to a study conducted by Harvey Rosen, increase in alar rim width accompany superior and anterior repositioning of the maxilla [ 7 ]. Thirty adult patients with vertical maxillary excess, who underwent Le Fort 1 impaction, were divided into 2 groups of 15 each.
The base of the nose was marked with 3 landmarks: 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.
Next, small amounts of the solution are injected beneath the alar bases and the nasolabial grooves to constrict the facial vessels.
An Alternative Alar Cinch Suture
Superior repositioning of the maxilla causes elevation of the nasal tip, widening of the alar bases, and a decrease in the naso-labial angle [ 4 ]. Published online Dec The nasal base changes were evaluated by the surgeon and the whole equipe. 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.
Excessive widening and superior retraction result in an ugly deepening of the alar-cheek groove, making the patient look older.
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. The width of the alar base was measured before operation, and then at one, and six months. Beginning posteriorly, sutures are placed through mucosa, submucosa, musculature, and periosteum in a staggered fashion bringing the upper vestibular mucosa in an anterior position along a rotational arch.
This article has been cited by other articles in PMC. Tip upturning and maxillary advancement: Nasal anatomy and maxillary surgery. Stewart A, Edler RJ.
National Center for Biotechnology InformationU. Our results showed a better stability in group 2 attributed to the method of suturing the nasolabial muscle to ANS that we follow. The incision is made at least mm above the mucogingival junction using a scalpel blade or an electrocautery needle.
An Alternative Alar Cinch Suture
The anterior nasal spine cinchh 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. Tension is applied until the desired alar ssuture is achieved, zlar then a fine artery forcep is used to clamp the suture ends at the point at which they exit the needle hub.
Results Group 2 showed a near pre-operative alar position compared to group 1. 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 ]. In a recent prospective, randomized, controlled trial study, Howley et al 10 assessed that the use of the alar cinch suture was effective in controlling the width of the alar base of the nose after Le Fort I osteotomy.
Regression Analysis Regression Equation for Group 1 For every unit increase of intrusion there was 0.