The effect of the alar base cinch suture in the treatment of Le Fort 1

osteotomy patients -a pilot study using a prospective randomised

controlled trial study design
Caitriona Howley, Shirley Cox
Results

Background
The Le Fort 1 osteotomy is a versatile procedure used to
correct a variety of dentofacial deformities of the maxilla.
The procedure is associated with unfavourable nasolabial
soft tissue changes including widening of the alar base width
of the nose.
The alar base cinch suture was initially advocated to correct
nasal defects associated with cleft lip deformities (Millard,
1980). It was later modified for use in non-cleft patients by
Collins and Epker (1982). The authors proposed that it
would:Control the width of the alar base of the nose
Create increased fullness of the subnasal area
Slightly increase the length
of the upper lip
Aim
The primary aim of this pilot study is to develop and pilot
methods for a prospective randomised controlled trial to
investigate the effect of an alar base cinch suture on the
change in the alar base width of the nose following a Le Fort
1 osteotomy procedure.

The Le Fort 1 osteotomy caused an increase in the alar base

width of the nose in all participants at six months post
surgery.
Alar base width
Cinch
Control
Total
Median

1.6

2.1

Interquartile Range

1.7

3.3

2.3

Table 1. Changes in the alar base width in millimetres,

from baseline to 6 month post surgery
A-B
Right eye width
B-D
Intercanthal width
D-E
Left eye width
C-F
Nasion to pronasale
F-G
Height of nasal base
H-K
Greatest alar width
I-J
Alar base width
G-L
Upper lip length
M-N Commisural width

Subjects and Method

The pilot study adopted a prospective randomised controlled
trial study design in accordance with CONSORT guidelines;
(Consolidated Standards of Reporting Trials, Altman et al.,
2001). In the intervention group (intervention A) an alar base
cinch suture was placed, in the control group (intervention B)
it was not. A standardised surgical technique was used. The
change in alar base width was determined post-operatively
with the use of a three-dimensional imaging system (an
optical surface laser scanner).
The inclusion criteria were, patients:
16 years and older
requiring a Le Fort 1 osteotomy with an anterior or superior
vector of maxillary movement
wearing fixed appliances with size 0.019 x 0.025 inch
stainless steel archwires in the upper and lower dental
arches
A. Assessment for eligibility
(n=22 )

B. Excluded (n=1 )
-Did not meet inclusion criteria (n=1)
-Refused to participate (n=0)
-Other Reasons (n=0)

C. Randomised (n=21)

D (i). Randomly allocated

to intervention A (n=11)
-Received intervention A
(n=11)
-Did not receive intervention A
(n=0)

D (ii). Randomly allocated

to intervention B (n=10)
-Received intervention B
(n=10)
-Did not received intervention
B (n=0)

E (i). Lost to follow up

(n=0)
-Discontinued intervention
(n=0)

E (ii). Lost to follow up

(n=0)
-Discontinued intervention
(n=0)

F (i). Analysed (n=10)

Excluded from analyses (n=1)
as treatment was performed
outside the time interval for
the studys conduct

F (ii). Analysed (n=10)

Excluded from analyses (n=0)

Figure 1. Flow diagram of participants progress

through the stages of this pilot study

Figure 2 and Table 2.

Landmarks measured on the
laser scan and definition of interlandmark measurements
respectively

The placement of an alar base cinch suture in participants

appears to lead to slightly less widening of the alar base
width of the nose, when compared to participants who did
not have an alar base cinch suture placed at surgery. The
median difference observed was small (0.5mm) which may
suggest that the placement of an alar base cinch suture may
not be relevant in clinical terms.
The range of changes in the alar base width however was
large, particularly in the control group of patients.

Conclusions

The main conclusions of this pilot study are:

Preliminary results of 20 patients suggest minimal
difference in the alar base width of the nose in the control
and intervention groups. This needs to be confirmed in a
study based on a larger sample of patients.
Agreement of the surgeons to follow a standardised surgical
procedure in the performance of a Le Fort 1 osteotomy has
been obtained.
The optical surface laser scanning mark and measure
system has been shown to be a valid and reproducible
method of quantifying nasolabial soft tissue changes
associated with the Le Fort 1 osteotomy.
Methods for a randomised controlled trial have been
developed.

References
Millard, D.R. Jr. (1980) The alar cinch in the flat flaring
nose.
Plastic and Reconstructive Surgery 65: 669-672
Collins, P.C. and Epker, B.N. (1982)
The alar base cinch: A technique for prevention of alar base
flaring secondary to maxillary surgery.
Oral Surgery, Oral Medicine, Oral Pathology 53: 549-553
Altman, D.G., et al (2001) The Revised CONSORT
Statement for Reporting Randomised Trials: Explanation and
Elaboration.
Annals of Internal Medicine 134: 663-694
Betts, N.J., et al(1993) Changes in the nasal and labial soft
tissues after surgical repositioning of the maxilla.
International Journal of Orthognathic Surgery 8: 7-23
Bell, W.H. (1975) Le Fort 1 osteotomy for correction of
maxillary deformities.
Journal of Oral Surgery 33: 412-426