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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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. 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. Finally the subperiosteal dissection moves behind the zygomaticomaxillary buttress into the region of the maxillary tuberosity and the pterygomaxillary fissure.
The alar base cinch suture to control nasal width in maxillary osteotomies. The post-operative results in group 2 compared to pre-op, frontal and sub-nasal view, is depicted in Figs. To achieve a good hemostatic effect, vasoconstrictive agents are applied at least 10 to 15 minutes before beginning surgery.
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Published online Dec Following suturf method, the nasal mucosa can be stripped successively. Aims and Objectives To assess the amount of alar flare.
They also suggested that a modified cinch suture may result in greater stability.
We also observed that resection of the base of the nasal septum wuture superiorly repositioning the maxilla reduces the height of the nasal septum thereby losing the tip projection and contributing to alar flare.
Total follow-up is now of 1 year. 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 ]. The use of submental intubation facilitated accurate measurement of the changes in nasal width produced by the osteotomy and the cinch suture. The muscles are exposed by grasping the alar facial groove between thumb and index finger.
Alar cinch was performed sutre an adjunct procedure in group 2 patients and results were compared to group 1 which was the control auture.
An Alternative Alar Cinch Suture
The nasal mucosa can be detached from the lateral wall, floor, or nasal septum with periosteal or Freer elevators, if necessary. This adds to the significance of the study. Group comparison using paired sample t test was found to be significant.
The range in both groups was large, indicating great individual variability. Another fine, curved artery forcep is used to clamp cnch sutures as they enter the blunt end of the needle. Le Fort 1 intrusion osteotomies are known to cause adverse effects on cinnch oro-facial soft tissues such as broadening of the alar alwr, loss of vermillion show of the upper lip and down sloping of the commissure [ 1 ].
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 needle is then pulled out of the skin in sufure inferolateral portion of the alar crease, which has been premarked; it is then reinserted into the mouth through the same puncture site. This study highlights the factors contributing sutuge the phenomenon of alar flare as a consequence of Le Fort 1 intrusion and the significance of alar cinch suture.
This article has been cited by other articles in PMC. InShams and Motamedi presented another modification of the alar cinch technique. Br J Oral Maxillofac Surg. Thirty adult patients with vertical maxillary excess, who underwent Le Fort 1 impaction, were divided into 2 groups of 15 each.
Soft tissue procedures on the nose, which can be performed simultaneously with a Le Fort 1 osteotomy, are sutrue alar cinch suture, resection of the anterior nasal spine, wedge excision of the alar base, grinding of the paranasal area, and thinning of the columella [ 2 ]. Indeed, the nasotracheal tube poses 2 problems: 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.
During wound closure, however, the tissue outstretches and can be easily grasped.
MustafaFatima Shehzanaand H. Distance measured between the center of the alar bases using vernier caliper. Study Design Thirty adult patients with vertical maxillary excess, who underwent Le Sutur 1 impaction, were divided into 2 groups of 15 each.
An Alternative Alar Cinch Suture
National Center for Biotechnology InformationU. The free ends of the sutures are tied into a firm knot against the forcep that hold them together.
Finally, the needle is retracted from the skin leaving the suture through the soft tissues.
Then the suture is passed through the opposite side in order to create a loop. 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. When the loop is tightened the alar bases are pulled medially. Sharp periosteal elevators are used to strip the soft tissues in the subperiosteal plane. The sutures are cut short, the forcep is released, and the knot can dig into the tissue channel made by the needle.
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. 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.
Maurice [ 6 ] describes important information stating that rotation of the palate does have significant effect on the soft tissue of the naso-labial region, also stating that changes in the lateral position of the pyriform aperture have significant effect on the soft tissue of the nasal base. The needle is then pulled out together with the artery forcep that holds the sutures until the blunt end of the needle is seen.
Our results showed a better stability in group 2 attributed to the method of suturing the nasolabial muscle to ANS that we follow. Twenty-eight patients were prospectively randomised into an intervention group where a cinch suture was used, and a control group. J Maxillofac Oral Surg. Then the medial and lateral bony buttresses are addressed: There were no major or minor complications.