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

Abstract

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.

Changes to the Cleft Nose Esthetic After Le Fort I Advancement: A 3-Dimensional Analysis

“…These changes have been previously well described using 2D analysis in noncleft patients, and include alar widening and flaring, upturning of the nasal tip, as well as flattening of the nasolabial region with thinning of the upper lip and increase in nasolabial angle. [15][16][17][18][19]21,28 Additional evaluation of the amount of Le Fort I advancement and its impact on the soft tissue changes in non-cleft patients using 3D analysis has shown that any advancement up to 10 mm can result in predictable soft tissue changes such as increased interalar widening and tip rotation. 15 This study attempts to further elucidate the soft tissue changes specific to the nasal complex following orthognathic surgery in the cleft patient population, and more specifically, differences among patients with UCLP and BCLP.…”

“…This effectively increases inter-alar width and results in altered nostril shape as well as nasal flare. 28 Additionally, subperiosteal dissection and osseous base expansion disinserts facial muscles causing lateral retraction resulting in widening and elevation of the nose as well as flaring. 28,32 Anterior maxillary advancement has a profound influence on the nasal morphology of the nasal tip and alar base secondary to tissue pressures, causing simultaneous lowering of the columella and advancement of the upper lip and alar bases.…”

“…28 Additionally, subperiosteal dissection and osseous base expansion disinserts facial muscles causing lateral retraction resulting in widening and elevation of the nose as well as flaring. 28,32 Anterior maxillary advancement has a profound influence on the nasal morphology of the nasal tip and alar base secondary to tissue pressures, causing simultaneous lowering of the columella and advancement of the upper lip and alar bases. This results not only in alar widening, but also nasal tip rise and deepening of the supratip depression.…”

“…35 Originally described by Millard 36 for use in patients with cleft lip, alar cinch sutures attempt to reapproximate fibroadipose tissue of the alar base and facilitate muscular reattachment at the correct anatomic site. 29 However, the efficacy of alar cinch sutures remains unclear, with several studies demonstrating their ability to control width and flare, 28,37 while others finding little benefit. 38,39 Thus, their effective utilization is likely a function of both the cinching technique used and surgeon judgment at the time of suture placement.…”

Review of Nasal Changes With Maxillary Orthognathic Surgery

“…Some surgeons have addressed this by using submental intubation ( 22 , 23 ) whilst others have suggested replacement of the naso-endotracheal tube with an oral endotracheal tube following stabilization of the maxilla and mandible ( 24 , 25 ). The effectiveness of alar base cinch sutures on minimizing alar widening is controversial, some in support, ( 23 , 25 , 26 , 27 , 28 ) whilst others stating no significant effect ( 29 , 30 ).A prospective randomized controlled trial found it provides a small and clinically insignificant decrease in alar width widening (0.5 mm) and concluded it was of ‘little benefit’ ( 29 ). On the other hand, a retrospective study found alar widening was statistically significantly reduced with the cinch suture compared to the control group, 1.6 mm and 2.3 mm respectively ( 28 ).…”