Alar Cinch Suture Research Articles

Clinical Evaluation of Modified Technique of Alar Base Cinch Suture to Prevent Widening of Alar Base.

Following Lefort I osteotomy, widening of the alar base is the most common secondary postoperative change resulting in deepening of the alar facial groove, which may be unaesthetic. Therefore, various surgical techniques to control lateralization of the alar base have been widely described in the literature. The purpose of this study was to analyze the cause and to prevent the changes in the nasolabial region, especially excessive widening of the alar base following Lefort I osteotomy by using modified alar base cinch suture. Twenty patients with the diagnosis of maxillary retrognathism or vertical maxillary excess requiring Lefort I osteotomy with superior repositioning or advancement were included in this prospective, non-randomized clinical study. Following Lefort I osteotomy, the widening of alar base was managed using modified alar base cinch suture. The mean alar width preoperatively was 41.09 ± .38mm, intra-operatively it was 43.69 ± .28mm, and after 6months, it was 41.93 ± .47mm. Statistical analysis using paired t test revealed that there was a significant change in alar width after placing alar base cinch suture. The results of the current study show that the modified alar cinch suture technique is effective in preventing flaring of the alar base in case of Lefort I osteotomies with superior repositioning or advancement.

Comparative study between three techniques for alar cinch sutures on bimaxilar orthognathic surgery. Double-blind randomized clinical trial.

Comparative study between three techniques for alar cinch sutures on bimaxilar orthognathic surgery. Double-blind randomized clinical trial.

Comparison of two alar cinch base suture in orthognathic surgery: a randomized clinical trial.

Le Fort I osteotomy is widely used in orthognathic surgery to correct maxillary deformities. However, this osteotomy may be related with the increase of alar base width. The aims of the present study were to compare two alar cinch suture after Le Fort I osteotomy and observe which type presents a better result in controlling the enlargement of the alar base after maxillary repositioning in orthognathic surgery. A randomized clinical trial was carried out with 40 patients randomly assigned in two intervention groups: group 1 - patients submitted to internal suture and group 2 - patients submitted to external suture. Of the 40 patients, 65% were female and 35% were male. The mean age of the patients was 30,25 in group I and 28,6 in group II. There was an increase in the alar base width in both groups, with significant difference between the means (P < 0,001). It was possible to compare the evolution of the means of the alar base width between group I and group II. Thus, it was observed that the external technique (group II) better controlled alar base width after Le Fort I osteotomy. It was not possible to relate the enlargement of the alar cinch with maxillary movement performed (P > 0,05). Overall, alar base cinch suture is an essential component of Le Fort osteotomies to control the alar base width. In this study, the external technique was more effective when compared to the internal technique in controlling the enlargement of the alar base width.

S Alar Cinch Suture Effective in Controlling Alar Base Widening in Le Fort 1 Osteotomy?

Le Fort I osteotomy causes nasolabial alterations that may be unattractive, such as expansion of the alae and alar bases and thinning of the upper lip. After maxillary impaction, there is a propensity for the tip to elevate, and in some circumstances, this may even become excessive. The nasolabial angle closes and similar alterations are observed with maxillary advancement. When Le Fort I impaction or maxilla advancement occurs, the alar base cinch suture is frequently utilised to reduce the unfavourable rise in nasal width. There are significant changes in the nasolabial morphology associated with Le Fort 1 osteotomy. Numerous changes occur after the surgical intervention in the maxilla namely- widening of the alar base of the nose, upturning of the nasal tip, flattening and thinning of the upper lip and down turning of the commissures. Widening of the alar bases of the nose appears to be the most common undesirable outcome. Some people may benefit aesthetically from nasal widening. For instance, the long face syndrome is frequently characterised by a narrow nose with a large dorsum. In these situations, superior maxillary relocation typically improves the look of the nose by enlarging the bases of the arches. However, excessive alar base broadening and superior retraction would cause the alar-facial groove to aesthetically deepen, giving the patient an older appearance, and may cause asymmetry in the alas. It is crucial for the surgeon to comprehend the preoperative aesthetic facial linkages and anticipate any potential impact the surgical operation may have on the nasolabial region before performing maxillary surgery. To control the width of the alar base after maxillary osteotomy clinicians have advocated the placement of cinch sutures, reduction of the anterior nasal spine and use of V-Y closure technique. There are inconstant opinions on the effect of the cinch suture.

The effect of subspinal Le Fort I osteotomy and alar cinch suture on nasal widening

The aim of this retrospective study was to evaluate the relationships between upper jaw movements and nasal soft-tissue changes in patients who have undergone subspinal Le Fort I osteotomy combined with alar cinch suture.Single and multivariate linear regression analyses were used to examine the relationships between greatest inter-alar width (GAW) and maxillary advancement, maxillary impaction, and rotational movements. The database of our referral hospital was searched for patients who had undergone upper jaw surgery with a subspinal LFI osteotomy to correct dentoskeletal deformities between April 2012 and June 2016.Thirty-eight of the patients (15 men and 23 women) who were identified were eligible for inclusion. The average change in inter-alar width (ΔGAW) was +1.7 ± 1.2 mm. GAW increased by 0.3 mm (p < 0.0001) for each millimetre of maxillary advancement, and increased by 0.5 mm (p < 0.0001) for each millimetre of maxillary impaction. GAW increased by 0.2 mm for each degree of counterclockwise rotation of the occlusal plane (p < 0.0001).An analysis of our data compared with the current literature confirmed that subspinal Le Fort I combined with alar cinch suture reduced alar base widening.

The cinch suture nasal sill excision combination technique for nasal base reduction in rhinoplasty

Alar base reduction is a procedure of balance between multiple structures of the lower nasal vault. This study aimed to describe the alar cinch suture nasal sill excision combination technique and to present our consecutive patient series. The cinch suture nasal sill excision combination technique is described in a step-by-step fashion and illustrated by pre-, post-, and intra-operative photographs, as well as videos. A study of consecutive patients presenting for primary rhinoplasty who required bilateral alar base reduction from October 2016 to October 2019 was performed. A total of 21 patients with a minimum of 12 months post-operative follow-up were included in the study. There were no major or minor complications. The technique involves dynamic manipulation of the nasal base structures and is highly applicable to every alar axis. The cinch suture nasal sill excision combination technique is a simple and durable technique for alar base reduction. It provides predictable outcomes while allowing for control of the lower nasal vault structures. Level of evidence: LeveI IV, therapeutic study.

Does the Nostril Shape Change After Le Fort I Advancement in Patients With Unilateral Complete Cleft Lip?

Patients with unilateral cleft lip and palate (UCLP) may require Le Fort I advancement to correct maxillary hypoplasia after reaching skeletal maturity. The underlying cleft anatomy, previous operations, and scarring can affect nostril changes after maxillary advancement. The purpose of the present study was to determine whether Le Fort I advancement affects the nostril configuration (ie, width, axis, shape) in patients with UCLP. The specific aims were to (1) compare cleft and noncleft nostrils in patients with UCLP after maxillary advancement and (2) compare the changes in nostril configuration in patients with UCLP with those in noncleft controls after Le Fort advancement. A retrospective case-control study of nonsyndromic, skeletally mature patients with UCLP and a case-matched control group without UCLP who had undergone single-piece Le Fort I advancement with alar cinch suture from 2010 to 2014. Patients were included if they had undergone pre- and postoperative 3-dimensional photogrammetry without intervening nasal revision. Three-dimensional anthropometry was used to evaluate changes in nostril axis and width, soft triangle angle, columellar show, and nasal width after orthognathic correction. The present study included 19 patients with UCLP (11 males; mean age, 18.0years) and 19 noncleft controls (11 males; mean age, 18.7years; P=.276). The mean sagittal advancement in the patients with UCLP and noncleft controls was 7.5mm and 6.3mm, respectively (P=.143). On average, the nostrils widened, the soft triangles flattened, and the columellar show increased. No significant difference was found in the changes to the nostril configuration between the cleft and noncleft sides in the patients with UCLP. No significant differences were found in the nostril changes between patients with UCLP and noncleft controls. Baseline nostril asymmetry is not altered by Le Fort osteotomy in patients with UCLP because both nostrils respond similarly to the deforming forces of maxillary advancement. Similarly, no differences were found in the nostril changes between the cleft and noncleft controls. These findings can aid proper surgical planning for cleft nasal revisions.

An orthodontic-orthognathic patient with obstructive sleep apnea treated with Le Fort I osteotomy advancement and alar cinch suture combined with a muco-musculo-periosteal V-Y closure to minimize nose deformity.

In some severe skeletal Class III patients, mandibular setback surgery using sagittal split ramus osteotomy (SSRO) is performed to correct mandibular protrusion. However, in patients diagnosed with obstructive sleep apnea syndrome (OSAS), the risk of OSAS worsening as a result of the SSRO is very high. Maxillary advancement could reduce the degree of mandibular retropositioning and expand the skeletal framework in the pharyngeal region, leading to enlargement of the airway. However, nasal deformity is an undesirable outcome of the procedure. This case report describes a 23-year-old man with a retruded maxilla and OSAS. The maxillary retrusion was treated using Le Fort I osteotomy with an alar cinch suture and a muco-musculo-periosteal V-Y closure (ACVY). After treatment, better occlusal relationships and improvement in OSAS were observed. Thus, an ACVY could minimize nasolabial deformity.

Three-dimensional virtual simulation of alar width changes following bimaxillary osteotomies

The aim of this study was to evaluate the accuracy of three-dimensional (3D) soft tissue simulation of nose width changes following bimaxillary osteotomies and to identify patient- and surgery-related factors that may affect the accuracy of simulation. Sixty patients (mean age 26 years) who underwent bimaxillary osteotomies participated in this study. Cone beam computed tomography scans were acquired preoperatively and at 1-year postoperative. The 3D hard and soft tissue rendered preoperative and postoperative virtual head models were superimposed, after which the maxilla and mandible were segmented and aligned to the postoperative position. The postoperative changes in alar width were simulated using a mass tensor model (MTM)-based algorithm and compared with the postoperative outcome. 3D cephalometric analyses were used to quantify the simulation error. The postoperative alar width was increased by 1.6±1.1mm and the mean error between the 3D simulation and the actual postoperative alar width was 1.0±0.9mm. The predictability was not correlated to factors such as age, sex, alar cinch suture, VY closure, maxillary advancement, or a history of surgically assisted rapid maxillary expansion. The MTM-based simulation model of postoperative alar width change was found to be reasonably accurate, although there is room for further improvement.

Three-dimensional evaluation of the alar cinch suture after Le Fort I osteotomy

Orthognathic surgery has an influence on the overlying soft tissues of the translated bony maxillomandibular complex. Improvements in both function and facial appearance are the goals of surgery. However, unwanted changes to the soft tissues, especially in the nose region, frequently occur. The most common secondary change in the nasolabial region is widening of the alar base. Various surgical techniques have been developed to minimize this effect. The purpose of this study was to evaluate the changes in the nasal region due to orthognathic surgery, especially the alar width and nasal volume, using combined cone beam computed tomography (CBCT) and three-dimensional (3D) stereophotogrammetry datasets. Twenty-six patients who underwent a Le Fort I advancement osteotomy between 2006 and 2013 were included. From 2006 to 2010, no alar base cinch sutures were performed. From 2010 onwards, alar base cinch sutures were used. Preoperative and postoperative documentation consisted of 3D stereophotogrammetry and CBCT scans. 3D measurements were performed on the combined datasets, and the alar base width and nose volume were analyzed. No difference in alar base width or nose volume was observed between patients who had undergone an alar cinch and those who had not. Postoperatively the nose widened and the volume increased in both groups.

Assessment of Alar Flare and Efficacy of Alar Cinch Suture in the Management of Alar Flare Following Le Fort 1 Superior Repositioning: A Comparative Study.

To prospectively analyze the amount of alar flare, factors contributing to alar flare and efficacy of cinch suture as an adjunctive procedure for alar flare reduction. Thirty adult patients with vertical maxillary excess, who underwent Le Fort 1 impaction, were divided into 2 groups of 15 each. Alar cinch was performed as an adjunct procedure in group 2 patients and results were compared to group 1 which was the control group. Measurements were made on the patients and on 1:1 standardized photographs. Group 2 showed a near pre-operative alar position compared to group 1. The alar flare resulting from every millimeter of impaction was significantly less in group 2 compared to group 1. 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.

Is the Pyriform Ligament Important for Alar Width Maintenance After Le Fort I Osteotomy?

To determine whether identification and incorporation of the pyriform ligament in the alar cinch results in decreased alar base widening compared with standard alar cinch techniques. This was a retrospective case series and the sample was composed of patients undergoing Le Fort I osteotomy. Intraoperatively, the pyriform ligament was identified and incorporated in the alar cinch suture. Greatest alar width (GAW) measured immediately after closure was compared with GAW measured at least 5 months postoperatively. The change in alar base width was compared with that reported in the literature using other alar cinch techniques. Two case examples are reported. The sample was composed of 15 patients (mean age, 27.1 yr; 27% female). The mean postoperative change in GAW was 1.0 ± 0.6 mm (2.59 ± 1.59%). Postoperative change in alar base width reported in the literature ranged from 0.5 to 10.8%. The pyriform ligament is easily identified during exposure of the maxilla and pyriform aperture and can be used to control widening of the alar base after Le Fort I osteotomy.

Comparison between the classical and a modified trans-septal technique of alar cinching for Le Fort I osteotomies: a prospective randomized controlled trial

The aim of this prospective randomized control trial was to analyse the efficacy of a new trans-septal alar base cinch suture in controlling alar width in patients undergoing maxillary intrusion and setback by comparing it with the traditional cinch suture. Statistical evaluation was carried out in 62 of 76 patients. Group I (31 patients) received the traditional alar base cinch suture, and group II (31 patients) received the alar base cinch suture with an anchoring bite taken through the nasal septum 10mm behind its anterior edge. In both groups the accurate identification of alar fibroareolar tissue was facilitated by an 18gauge green needle passed extra orally. Alar base width was measured before and 6 months after surgery using Vernier callipers. Preoperative alar base width for group I was 29.76mm (1.901SD) and for group II 29.79mm (3.141SD); the postoperative values were 32.42mm (1.858SD) and 29.94mm (2.568SD), respectively. Mean alar base widening was 2.661mm (0.800SD) in group I and 0.145mm (2.050) in group II. The difference in alar widening was statistically significant (p<0.001). In conclusion, the trans-septal modified alar cinch suture offers better control of alar base architecture in maxillary intrusion and setback.

The influence of a Le Fort I impaction and advancement osteotomy on smile using a modified alar cinch suture and V-Y closure: a prospective study

A previous report from the authors’ department showed that a modified alar cinch suture combined with a muco-musculo-periosteal V-Y closure (mACVY) improves nasolabial mobility. To test if the improvements were equal to the range of nasolabial mobility in non-dysgnathic persons, a prospective study was carried out in 56 patients: 31 with mACVY, 25 with simple closing sutures (SCS) and 18 non-operated, angle class I volunteers. Standardized full facial frontal photographs, taken immediately preoperatively and 18 months postoperatively were used. The landmarks, alare, crista philtri and cheilion were analysed. The test has a standard deviation of 0.9mm. Intra-group changes, paired t-test, and inter-group differences, unpaired t-test (p<0.05) were statistically analysed. The results show significant preoperative differences in nasolabial mobility compared with the control group, for both groups. Postoperative mobility improved in both groups, but significantly with mACVY with horizontal movement of cheilion and alare, and the vertical movement of crista philtri and less so for the vertical movement of crista philtri with SCS. Postoperative inter-group differences in mobility were small and significant for SCS vs the control group. It can be concluded that using mACVY improves orofacial movement to the level of normal class I volunteers.

The evaluation of the nasal morphologic changes after bimaxillary surgery in skeletal class III maloccusion by using the superimposition of cone-beam computed tomography (CBCT) volumes

BackgroundThe purpose of this study was to evaluate nasal morphologic and maxillary skeletal changes occurring after bimaxillary surgery in skeletal class III patients, using a new method entailing superimposition of cone-beam computed tomography (CBCT) volumes. Materials & methodsThe subjects consisted of 30 adults (15 males and 15 females) who had presented with skeletal class III deformities. The subjects underwent Le Fort I advancement and impaction osteotomy and mandibular setback surgery. For closure of the maxillary vestibular incision, alar cinch suture and V-Y closure were performed. The pre- and post-operative CBCT data were superimposed and evaluated by voxel-by-voxel registration. ResultsAfter surgery, the nasolabial angle, nasal tip angle, nasal tip inclination and columellar angle showed significant increases (P < 0.01). The nasal tip protrusion and nasal height, meanwhile, had significantly decreased (P < 0.01), and the alar base width had increased (P < 0.01). The columellar length and nostril axis angle also had decreased, but the nostril area did not show any significant change. ConclusionsAfter surgery, as the maxilla had been moved upward and forward, the nasal tip was shifted antero-superiorly and the alar base width and nostrils were widened. CBCT superimposition, enabling 3D assessment of nasal morphologic changes, can be an effective tool for simultaneous measurement of skeletal and soft-tissue changes.

The stability of an alar cinch suture after Le Fort I and mandibular osteotomies in Japanese patients with Class III malocclusions

We previously reported a modified technique for the placement of symmetrical cinch sutures after switching from a nasal to an oral endotracheal tube. We undertook a study to assess the effectiveness of our technique and the stability of changes in the nasolabial morphology after bimaxillary surgery. The study group comprised 30 patients aged 17–36 years who had skeletal Class III malocclusion. All patients had bimaxillary surgery with an alar base cinch suture and V-Y closure. The nasal region was measured directly or on cephalograms before, and 1 week and 1 year after operation. The suture did not alter the width of the alar base, but the nasolabial angle and projection of the tip increased significantly. The length of the upper lip did not change significantly.

A Prospective Study on the Effect of Modified Alar Cinch Sutures and V-Y Closure Versus Simple Closing Sutures on Nasolabial Changes After Le Fort I Intrusion and Advancement Osteotomies

The purpose of this study was to determine whether a modified alar cinch suture and V-Y closure (mACVY) have a beneficial effect on labial form after Le Fort I intrusion and advancement osteotomies and whether they result in excessive upward nasal tip rotation. Both are possible effects compared with simple closing sutures (SCS). A prospective study was carried out on 56 patients, 31 with mACVY and 25 with SCS. Lateral cephalograms taken immediately before and 18 months after operation were used, measuring horizontal and vertical changes of the following landmarks: anterior and posterior nasal spine, A-point, incision superior, pronasale, subnasale, labiale superior, and stomion superior, as well as angular changes of sella-nasion-pronasale, and changes in upper vermilion exposure. Statistical analysis was performed on intragroup, paired t test, and intergroup differences, unpaired t test (P < .05). The horizontal and vertical changes of labiale superior were significantly larger for mACVY versus SCS, and the angle sella-nasion-pronasale increased in mACVY versus SCS. However, no significant difference was found for vertical changes of the nasal tip. Upper vermilion exposure increased with mACVY versus SCS. mACVY has a beneficial effect on labial form, and excessive upward rotation of the nasal tip is prevented.

The effect of alar cinch sutures and V-Y closure on soft tissue dynamics after Le Fort I intrusion osteotomies

Adverse effects on the soft tissues after Le Fort I osteotomies include: broadening of the alar base, loss of vermilion show of the upper lip and down sloping of the commissures. In theory, an alar cinch suture combined with a muco-musculo-periosteal V-Y closure (ACVY) should improve not only the nasal width, but would also improve the dynamics of some of the mimic muscles. To test the validity of this hypothesis, a prospective study was set up including 22 patients, using standardized full facial frontal photographs, taken immediately preoperatively and 18 months postoperatively. Sets containing three pictures were made: soft tissue in repose, maximum closed mouth smile and maximum smile. The landmarks, alare, crista philtri and cheilion were analysed. The preliminary results show that ACVY-closure does significantly improve the horizontal movement of cheilion with both maximum closed mouth smile and maximum smile, as well as the vertical movement of crista philtri with maximum closed mouth smile. The Le Fort I osteotomy with ACVY improves the orofacial dynamics.

O.356 3D comparison of swelling following orthognathic surgery

A previous report from the authors’ department showed that a modified alar cinch suture combined with a muco-musculo-periosteal V-Y closure (mACVY) improves nasolabial mobility. To test if the improvements were equal to the range of nasolabial mobility in non-dysgnathic persons, a prospective study was carried out in 56 patients: 31 with mACVY, 25 with simple closing sutures (SCS) and 18 non-operated, angle class I volunteers. Standardized full facial frontal photographs, taken immediately preoperatively and 18 months postoperatively were used. The landmarks, alare, crista philtri and cheilion were analysed. The test has a standard deviation of 0.9 mm. Intra-group changes, paired t-test, and inter-group differences, unpaired t-test (p < 0.05) were statistically analysed. The results show significant preoperative differences in nasolabial mobility compared with the control group, for both groups. Postoperative mobility improved in both groups, but significantly with mACVY with horizontal movement of cheilion and alare, and the vertical movement of crista philtri and less so for the vertical movement of crista philtri with SCS. Postoperative inter-group differences in mobility were small and significant for SCS vs the control group. It can be concluded that using mACVY improves orofacial movement to the level of normal class I volunteers.

Nasal Changes after Surgical Correction of Skeletal Class III Malocclusion in Koreans

To quantify the changes in the nose after bimaxillary surgery to correct skeletal Class III malocclusion and to test the hypothesis that there is no change in the nasal width following bimaxillary surgical correction of skeletal Class III when a nasal cinch is properly used. Sixty-five adult Korean skeletal Class III patients who had received maxillary advancement/impaction and mandibular set-back surgery in conjunction with an alar base cinch suture were evaluated. The anthropometric variables of the nasal region were measured directly on the soft-tissue surface before and 6 months after surgery. After surgery, the alar width and alar base width had increased significantly (P < .001), while the nasal tip projection decreased (P < .001). The nostril morphology also showed widening (P < .001). There was a trend for females with a narrow alar width presurgically to have a larger amount of nasal widening compared with those with a broader alar width (P < .05). There is a high probability of nasal and nostril widening after bimaxillary surgery for skeletal Class III malocclusion in Koreans despite the careful performance of alar cinch suture. Nevertheless, the authors believe that alar cinch suture was positive in limiting the nasal widening to the minimum and would consider routine application during bimaxillary surgery for skeletal Class III especially for female patients with a narrow nose who are susceptible to these changes.