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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AO Surgery Reference
Final tightening of the sutures is done after extubation and with the patient fully awake or even several days after the surgery. The alar flare resulting from every millimeter of impaction was significantly less in group 2 compared to group 1. There was a statistically significant increase in post operative interalar width and inter-nostril width with maxillary movement.
J Maxillofac Oral Surg. Aims and Objectives To assess the amount of alar flare. Use of the alar base cinch suture in Le Fort I osteotomy: The article is distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
InShams and Motamedi presented another modification of the alar cinch technique. J Oral Maxillofac Surg. Le Fort I osteotomy alters the proportion of the alar base and widens it, the superior or anterior maxilla movement has the most effect. Intergroup comparison was done by independent sample t test and it pronounced the following results: Tension is applied until the desired alar width is achieved, and then a fine artery forcep is used to clamp the suture ends at the point at which they exit the needle hub.
Nasal widening is commonly associated to maxillary osteotomies, but it is only partially dependent on the amount of skeletal movement. 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 ].
An Alternative Alar Cinch Suture
Compliance with Ethical Standards Conflict of interest None. InLoh 8 proposed a modification of the technique of alar base cinching, cich be used in presence of nasotracheal intubation, often used during orthognathic surgery.
Other contributing factors include detachment of muscle insertion from its origin and the muscle tends to reattach at a shortened length because of contraction. The suture is pulled back and forth several times until it is embedded under the skin into the dermis to prevent an unsightly dimple. The Le Fort 1 osteotomy results in unpredictable soft tissue changes, which can be difficult to control because of considerable variation in their adaption.
This study highlights the factors contributing to the phenomenon of alar flare as a consequence of Le Fort 1 intrusion and the significance of alar cinch suture.
The needle is retracted through the skin point without leaving it, then returned to the oral cavity again in a medial position. Lip—nasal aesthetics following Le Fort I osteotomy. Nasal anatomy and maxillary surgery. Finally the subperiosteal dissection moves behind the zygomaticomaxillary buttress into the region of the maxillary tuberosity and the pterygomaxillary fissure.
Palpation of the piriform rim and anterior nasal spine ensures incision placement below these structures. Sharp periosteal elevators are used to strip the soft tissues in the subperiosteal plane. 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 ]. This article has been cited by other articles in PMC.
This tissue cuff will contract immediately after cutting.
A line of a local anesthetic mixed with epinephrine 1: This compromised space culminates in the naso-labial muscles being pushed laterally and thereby causing an increase in the inter-alar width resulting in post-operative nasal flare.
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. alad
alr 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 anterior nasal spine and caudal septum junction, the infraorbital nerve exit and canine fossa, as well as the maxillary tuberosity and pterygopalatine fossa region are infiltrated with additional small quantities of the mixture.
The incision is made at least mm above the mucogingival junction using a scalpel blade or an electrocautery needle. The range in both groups was large, indicating great individual variability.
A hockey stick shaped incision with a 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. Group comparison using paired sample t test was found to be significant. 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.
This reduction in the depth of the nasal aperture does not provide adequate space for the alar base to occupy.
The base of the nose was marked with 3 landmarks: Rauso et al 11 have previously shown that this modification is more effective than the classic technique. The width of the alar base was measured before operation, and then at one, and six months.