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 also noticed cinch suturing was effective in sutuee the alar flare increase following the intrusion. A line of a local anesthetic mixed with epinephrine 1: This prevents the sutures from sliding back into the tissues. 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.
InShams suuture Motamedi presented another modification of the alar cinch technique.
Eur J Plast Surg. General consideration The maxillary vestibular approach is simple and safe, as long as the dissection proceeds strictly in the subperiosteal plane. Alar cinch suture restores the normal alar width by preventing the suutre drift of the naso-labial muscle and thereby reducing the postoperative nasal flare significantly.
The vertical height of the incision line leaves an inferior cuff of moveable mucosa and buccinator muscle on the alveolus that will facilitate closure.
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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 Conch I osteotomy.
Many studies have reported secondary icnch changes in the nose, including alar flaring after a Le Fort 1 osteotomy. 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.
The nasal base changes were evaluated by the surgeon and the whole equipe. Fifteen patients were subjected to endonasal intubation and underwent Le Fort 1 osteotomy with superior repositioning combined with cinch suturing.
Another fine, curved artery forcep is used to clamp the sutures as they enter the blunt end of the needle. 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.
Points marked to measure the maximum convexity of the ala and alar base. Following this method, the nasal mucosa can be stripped successively.
An Alternative Alar Cinch Suture
Though the overall morbidity is low, potential complications can occur from violating some anatomic structures:. Open in a separate window. In this article, authors report the effect of a new alar cinch suture technique on a sample of 32 patients.
Tip upturning and maxillary advancement: The first forcep is then removed together with the needle. Open in a separate window. The same procedure is done through the skin point at the other side of the nose. As soon as the correct plane is reached, the dissection is continued bluntly. Muscle re-orientation following superior repositioning of the maxilla. The amount of subperiosteal dissection performed, which involves the total surface of the maxilla, seems to play a major role.
National Center for Biotechnology InformationU. Study Design Thirty adult patients with vertical maxillary excess, who underwent Le Fort 1 impaction, were divided into 2 groups of 15 each. The alar base cinch: Distance measured between the center of the alar bases using vernier caliper.
The maxillary vestibular approach is simple and safe, as long as the dissection proceeds strictly in the subperiosteal plane. Different movements of the maxilla have distinct effects on the nasal morphology. J Maxillofac Oral Surg. Br J Oral Maxillofac Surg.
Use of the alar base cinch suture in Le Fort I osteotomy: is it effective?
Siture sutures are cut short, the forcep is released, and the knot can dig into the tissue channel made by the needle. The incision is carried down through the mucosa, submucosa, underlying facial muscles and periosteum …. The alar base cinch suture to control nasal width in maxillary osteotomies.
The nasal mucosa can be detached from allar lateral wall, floor, or nasal septum with periosteal or Freer elevators, if necessary. Excessive widening and superior retraction result in alat ugly deepening of the alar-cheek groove, making the patient look older. According to a study conducted by Harvey Rosen, increase in alar rim width accompany superior and anterior repositioning of the maxilla [ 7 ].
Exclusion Criteria All orthognathic procedures not performed on maxilla. Br J Oral Maxilofac Surg.
The only limit is due to the use of suturf curved needle, which is difficult to insert in the desired direction and pass through the same hole. A modified alar cinch suture technique.
An Alternative Alar Cinch Suture
This adds to the significance of the study. The alar flare resulting from every millimeter of impaction was significantly less in group 2 compared to group 1.
Nasal widening is commonly associated to maxillary osteotomies, but it is only partially dependent on the amount of skeletal movement. However, if a wide preoperative alar base is present, these same changes become undesirable, especially with anterior or superior repositioning of the maxilla.
This leads to inversion of the upper lip, flattening of the nose decrease in tip projectionand flaring of the nasal cinnch bases. Contact Disclaimer AO Foundation.
Then the medial and lateral bony buttresses are addressed: A new technique of alar base cinching following maxillary osteotomy. Support Center Support Center.