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

Abstract

Introduction: 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.

Materials and method: 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.

Result: The mean alar width preoperatively was 41.09 ± .38 mm, intra-operatively it was 43.69 ± .28 mm, and after 6 months, it was 41.93 ± .47 mm. Statistical analysis using paired t test revealed that there was a significant change in alar width after placing alar base cinch suture.

Discussion: 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.

Keywords: Alar base cinch suture; Alar base widening; Lefort I osteotomy; Orthognathic surgery.

Fig. 1

Suture grasping the tissues of the alar base from the intraoral incision

Fig. 2

Transection of the needle from the intraoral incision to the skin extraorally

Fig. 3

Suture needle exiting through the intraoral incision in a different direction

Fig. 4

Alar base cinch suturing performed on the contralateral side

Fig. 5

Anchorage of bilateral alar base tissue was confirmed by applying tension cinch suture