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

Abstract 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.

Resumo A osteotomia Le Fort I é amplamente utilizada em cirurgia ortognática para corrigir as deformidades maxilares. No entanto, esse tipo de osteotomia pode estar relacionado ao aumento da largura da base alar. Os objetivos do presente estudo foram comparar duas técnicas de sutura da base alar após a realização da osteotomia Le Fort I, bem como observar qual tipo apresenta melhor resultado no controle do alargamento da base alar após o reposicionamento maxilar em cirurgia ortognática. Foi realizado um ensaio clínico randomizado com 40 pacientes alocados aleatoriamente em dois grupos de intervenção: grupo 1 - pacientes submetidos à técnica de sutura interna e grupo 2 - pacientes submetidos à técnica de externa. Dos 40 pacientes, 65% eram do sexo feminino e 35% do masculino. A média de idade dos pacientes foi de 30,25 no grupo I e 28,6 no grupo II. Houve aumento da largura da base alar em ambos os grupos, com diferença significativa entre as médias (P <0,001). Foi possível comparar a evolução das médias da largura da base alar entre o grupo I e o grupo II. Assim, observou-se que a técnica externa (grupo II) controlou melhor a largura da base alar após a osteotomia Le Fort I. Não foi possível relacionar o alargamento da base alar com o tipo de movimentação maxilar realizado (P> 0,05). No geral, a sutura da base alar é um componente essencial das osteotomias Le Fort para controlar o alargamento da base alar. Nesse estudo, a técnica externa foi mais eficaz quando comparada à técnica interna no controle do alargamento da largura da base alar.

Anatomical control of the lower nasal width in Le Fort I osteotomy / Control anatómico del ancho nasal inferior en osteotomía Le Fort I

SUMMARY: The aim of this research is to show a simple technique to obtain control in the alar base width in Le Fort I osteotomy. The technique was used in eighteen patients submitted to maxillary impaction and/or advancements (≥ 3 mm). Inter-alar width, alar base width and right/left nostril were studied before surgery and 6 months of follow-up. Data were reported as means and standard deviations; statistical analysis was realized by t test considering a p-value <0.05. Left nostril was modified 0.33 ± 1.03 mm, right nostril was modified 0.39 ± 0.98 mm after 6 months and inter-alar width show a decrease of 0.17 ± 1.15 mm. No statistical differences were observed between the preoperative and the postoperative measurements. Our results show this technique as effective in to obtain a stable position in nasal width.

RESUMEN: el objetivo de esta investigación es presentar una técnica simple para obtener el control en el ancho de la base alar en la ejecución de una osteotomía de Le Fort I. La técnica fue usada en 18 sujetos sometidos a cirugía maxilar de ascenso y/o avance maxilar mayor (≥ 3 mm). El ancho inter-alar, el ancho de la base alar y el orificio nasal derecho e izquierdo fueron estudiados antes de la cirugía y seis meses después de la misma. Los datos fueron presentados en promedios y desviación estándar; el análisis estadístico fue realizado utilizando el t test considerando un valor de p <0,05. El orificio izquierdo fue modificado en 0,33 ± 1,03 mm, el orificio izquierdo fue modificado en 0,39 ± 0,98 mm des- pués de 6 meses y el ancho inter alar mostro una reducción de 0,17 ± 1,15 mm. No se observaron diferencias estadísticas entre las mediciones obtenidas previo a la cirugía y después de la cirugía. Nuestros resultados muestran que la técnica es efectiva para obtener una posición estable del ancho nasal.

The application of diced cartilage in postoperative nasal deformity of cleft lip surgery / 中华整形外科杂志

Objective@#To investigate the clinical effect of diced cartilage in correcting nasal alar base depression after cleft lip surgery.@*Methods@#A retrospective study was conducted in 15 patients of nasal deformity after lip surgery from January 2018 to January 2019. All the patients were taken from autologous costal cartilage to reconstruct the outline of nasal malformation, and the remaining autologous costal cartilage was cut into 0.5-1.0 mm pieces and filled into the basilar lacunar space of the nasal alar by the 1 ml syringe whose anterior needle nipples was removed. The effects of visual images before and after operation were compared and analyzed by Adobe Photoshop CS6 software. The patients were followed up for 6-15 months (mean 10months). The satisfaction and complications of the patients were investigated.@*Results@#The nasal alar base was significantly elevated and the outline of the nasal deformity was improved in 15 patients after operation. The overall effect was satisfactory and no obvious complications were found. No obvious absorption was found in the follow-up.@*Conclusions@#The application of diced cartilage to correct the nasal alar base depression after cleft lip surgery was a feasible method with important clinical value. It advanced in taking good use of the remaining cartilage and reducing the damage to both the donor and recipient area.

Alar Base Augmentation by Various Methods in Secondary Lip Nasal Deformity

The definitive correction of secondary lip nasal deformities is a great challenge for plastic surgeons. To rectify the secondary lip nasal deformities, various procedures and its modifications have been reported in many centers. However, no universal agreement exist to correct the various components of secondary nasal deformities. The secondary nasal deformity of the unilateral cleft lip has its own characteristic abnormalities including the retroplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, short columella, depressed alar base and so forth. Among these components of secondary nasal deformity, maxillary hypoplasia, especially in the area of piriform aperture, and alveolar bone defect can make the alar base depressed, which in turn, leads to wide and flat nasal profile, obtuse nasolabial angle coupled with subnormal nasal tip projection in aspect of aesthetic consideration. Moreover, the maxillary hypoplasia contributes to reduced size of the nasal airway in combination with other component of external nasal deformity and therefore the nasal obstruction may be developed functionally. Therefore, the current authors have performed corrective rhinoplasty with the augmentation of alar base with various methods which include rearrangement of soft tissue, vertical scar tissue flap and use of allogenic or autologous materials in 42 patients between 1998 and 2003. The symmetric alar base could be achieved, which provides the more accurate evaluation and more appropriate management of the various component of any coexisting secondary nasal deformity. In conclusion, the augmentation of alar base, as a single procedure, is a basic and essential to correct the secondary lip nasal deformities.

A Surgical Method For The Effective Treatment Of Cleft Alveolus, Especially For The Elevation Of Ala Base

Samsung Medical Center, Sungkyunkwan university, School of Medicine The cleft alveolus is one of three parts in cleft deformity. The purpose of cleft alveolus bone grafting is the recovery of normal esthetics, occlusion and speech. If a bony defect is extended to the nasal floor, especially wide bony defect at the ala base, it is difficult to condense the cancellous bone during bone transplantation and to reconstruct the normal anatomy at the alar base. We treated with above mentioned cleft alveolus patients using the autogenous cortical bone effectively. We report this technique with two cases and the literatures review.