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

Prospective assessment of maxillary advancement effects: Maxillary incisor exposure, and upper lip and nasal changes

“…We found smaller vertical ratios for upper lip soft tissue response to hard tissue (A-point or maxillary incisor tip) movement compared with the ranges reported in previous studies: pronasale, 0.28-0.52 (this study, 0.14), subnasale, 0.54-0.63 (this study, 0.18), and labrale superius, 0.33-0.96 (this study, 0.48). 11,17 However, the range of 18% to 48% for upper lip soft tissue vertical movement to maxillary impaction was similar to the 25% to 50% found by Muradin et al 12 Upper lip shortening and thinning has been found to be correlated to maxillary advancement procedures. 7,9,17,28 In this study, thinning was insignificant, but an interesting trend was noted with regard to decreased upper lip elevation at labrale superius relative to the maxillary advancement at the maxillary incisor tip with increasing presurgical upper lip thickness.…”

“…The range of the mean horizontal soft to hard tissue ratios from pronasale to stomion superius found in many studies [4][5][6][7][11][12][13][14][15][16][17] (pronasale, 0.24-0.35; subnasale, 0.26-0.64; labrale superius, 0.36-1.43; stomion superius, 0.31-1.43) reflects a pattern where soft tissues from pronasale to labrale superius increasingly follow more closely the hard tissue movement, with labrale superius and stomion superius moving at similar ratios. 18 Vertical ratios of soft to hard tissue movement are less well documented and demonstrate greater variability among studies.…”

“…11,17 In general, the upper lip soft tissue moves by 25% to 50% of the maxillary vertical movement. 12 Several potential variables may affect the ratio of soft to hard tissue movement after a LeFort I osteotomy: patient factors (sex, age), ethnicity, 19 amount and direction of surgical movement, 6 and lip thickness. 20 Furthermore, a number of surgical adjunctive techniques are available to surgeons to attempt to limit unwanted soft tissue changes as a result of maxillary surgery.…”

Ostéotomie de Le Fort 1 : gérer les tissus mous pour contrôler les modifications du nez

“…Plus précisément, la chirurgie de Le Fort 1 peut produire des modifications des téguments naso-labiaux comme un élargissement de la distance inter-alaire, un relèvement de la pointe du nez et un amincissement de la lèvre supérieure [6]. L'augmentation de largeur de la base du nez qui accompagne l'ostéotomie peut se révéler indésirable, surtout pour les patients qui présentent une largeur préopératoire normale ou déjà plus importante que la moyenne [5]. La cause de ces changements est multi-factorielle.…”

“…La cause de ces changements est multi-factorielle. L'amplitude et la direction du déplacement du plateau maxillaire, la désinsertion des muscles comme le transverse nasalis au moment de l'incision vestibulaire, la gestion de l'épine nasale antérieure contribuent tous à l'altération de l'anatomie naso-labiale [5,6].…”