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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Br J Oral Maxillofac Surg. The nasolabial musculature along the piriform aperture is detached, followed by a dissection over the zygomaticomaxillary crest and the anterior surface of zygomatic body. All the patients had bimaxillary operations, with or without genioplasty. 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.

Prior to closing the mucosal incision of the maxillary vestibule, two strategies to compensate for contraction of the stripped nasolabial muscles are possible: 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. In the sample, there were 13 men and 19 women, average age Abstract Nasal widening is commonly associated to maxillary osteotomies, but it is only partially dependent on the amount of skeletal movement.

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 ].

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

Fifteen patients were subjected to endonasal intubation and underwent Le Fort 1 osteotomy with superior repositioning with no adjunctive procedure.

We also observed that resection of the base of the nasal septum while superiorly repositioning the maxilla reduces the height of the nasal septum thereby losing the tip projection and contributing suturre alar flare. Study Design Thirty adult patients with vertical maxillary excess, who underwent Le Fort alxr impaction, were divided into 2 groups of 15 each.

To counteract the lateral pull of sutjre orbicularis oris muscle, the upper vestibular incision is closed in a V-Y advancement fashion. The amount of subperiosteal dissection performed, which involves the total surface of the maxilla, seems to play a major role.

Acknowledgments Appreciation is extended to Mrs. Use of the alar base cinch suture in Le Fort I osteotomy: Then the suture is passed through the opposite side in order to create a loop. Suturf compromised space culminates in the naso-labial muscles being pushed laterally and thereby causing an increase in the inter-alar width sutuee in post-operative nasal flare. A modified alar cinch suture technique.


The suture is tied only if the cinching effect is adequate; otherwise, the maneuver has to be repeated. There was an overall reduction in the width of the alar base between one and six months after operation, which indicated some resolution of soft tissue oedema associated with the operation, but the median reduction was small and unlikely to be clinically significant.

However, if a wide preoperative alar base is present, these same changes become undesirable, especially with anterior or superior repositioning of the maxilla. The alar base cinch: The alar base cinch suture to control nasal width in maxillary osteotomies. A line of a local anesthetic mixed with epinephrine 1: The same procedure is done through the skin point at the other side of the nose.

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

This study highlights slar factors contributing to the phenomenon of alar flare as a consequence of Le Fort 1 intrusion and the significance of alar cinch suture.

Int J Oral Maxillofac Surg. The alar cinch suture brought in a significant reduction in alar flare when compared to group 1 where superior reposition was done without any adjuvant procedure especially when the suture is passed through the anterior nasal spine.

Recently a number of studies have looked at the stability and clinical outcome of this intervention.

Compliance with Ethical Standards Conflict of interest None. Our study confers these findings to some extent. In our study we observed that for every unit increase in the intrusion there is 0.

Results Group 2 showed a near pre-operative alar position compared to group 1. The freeing of the facial muscles from the nasolabial area and the anterior nasal spine allows the muscles to retract laterally, which results in flaring, widening, and raising of the base of the nose, which is commonly asymmetrical.

Articles from Eplasty are provided here courtesy of Open Science Co. The changes might be advantageous for patients with a narrow nose, but they can have a negative effect on the overall esthetics of the face in those with a wide nasal width [ 3 ].

Preoperative interalar width was assessed by measuring the maximum convexity of the ala with the help of a vernier caliper Fig. The technique presented by the authors shows the advantages of cinhc use of a straight needle passing in the same hole without going out from the skin point, this allows the surgeon to control the narrowing of the alar base, anchoring enough soft tissue avoiding postoperative relapse, and avoiding the risk cincb skin infection in the area to be narrowed too.


This prevents the sutures from sliding back into the tissues. What is more important is the degree of subperiosteal dissection and the amount of soft tissue elevated, that in most surgical techniques involves the total maxilla.

An Alternative Alar Cinch Suture

To achieve a good hemostatic effect, vasoconstrictive agents are applied at least 10 to 15 minutes before beginning surgery. The nasal base changes were evaluated by the surgeon and the whole equipe. This reduction in the depth of the nasal aperture does not provide adequate space for the alar base to occupy. Lip—nasal aesthetics following Le Fort I osteotomy. The vestibular mucosa is advanced with a skin hook in the midline to pull the soft-tissue envelope anteriorly.

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 incision is made at least mm above the mucogingival junction using a scalpel blade or an electrocautery needle.

The tip of the nose turns upwards, the naso-labial angle might increase and the maximal alar width increases. The technique for controlling lateralization of the ala, including the alar base 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 noncleft patients, and later modified by others.

The free ends of the sutures are tied into a firm knot against the forcep that hold them together. Post-operative changes in alar flare following intrusion in 15 patients each of group 1 and group 2 measurements in mm.

Many studies have reported secondary morphological changes in the nose, including cinvh flaring after a Le Fort 1 osteotomy. Exclusion criteria were cleft lip, previous nasal operation, and previous or simultaneous additional midfacial operations.

The median increase was greater in the control group than in the cinch placement group, but the difference was small.