1
Introduction
Le Fort I osteotomy, which is a common surgical procedure for correcting midface deformities [ ], can lead to soft-tissue and bone alterations, particularly around the nasolabial area and anterior nasal spine [ , ]. These changes can cause complications such as excessive widening and retraction of the alar base, facial asymmetry, and deepening of the ala–cheek groove, which can make the patient appear older [ ].
The standard technique for addressing these issues is the alar base cinch suture, which prevents the expansion of the alar base [ ]. However, this technique may not fully address changes in the overall alar morphology, especially when considering the extensive periosteal dissection required for plate fixation around the piriform aperture. Despite various improvements in the cinch suture technique [ ], no study has reported the use of a cinch suture in the supra-alar groove.
Here, we propose a novel technique called double-cinch suturing (DCS). This method involves placing two cinch sutures, one each in the bilateral supra-alar grooves and one each in the bilateral alar bases, both passing through the anterior nasal spine. DCS aims to symmetrically prevent excessive widening and superior retraction of the nasal alae, offering an enhanced solution to aesthetic concerns arising from Le Fort I osteotomy.
2
Technique
DCS is performed preoperatively using a gastric tube placed in the unintubated nostril to ensure nasal symmetry ( Fig. 1 ). Skin hooks are used to expand the surgical field during the procedure. An 18-gauge needle is inserted through the supra-alar groove on one side and exited through the fibroareolar tissue in the lateral position. An absorbable 2-0 polyglactin (Vicryl) suture is passed through the needle from the oral cavity ( Fig. 2 ) and the needle with the suture is retracted through the subcutaneous tissue and exited medially. The suture in the needle is pulled into the oral cavity and the needle without the suture is removed. Next, the suture is passed through a hole in the anterior nasal spine. This process is repeated on the opposite side from medial to lateral. Finally, both suture ends, which are in a lateral position, are passed through the anterior nasal spine from each side. In total, the suture passes through the hole three times. This procedure is repeated at the alar base. In total, the two sutures are passed through the anterior nasal spine six times ( Fig. 3 ). Thus, the hole in the nasal spine must be relatively large to accommodate the sutures. The sutures from the bilateral supra-alar grooves are tightly ligated, whereas those from the bilateral alar bases are ligated such that the alar base width reduces by 5 mm compared to that preoperatively ( Fig. 4 )( Fig. 5 ).
