The effect of alar cinch sutures and V-Y closure versus simple closing sutures after Le Fort I osteotomies on nasolabial esthetics and dynamics

Surgical reposition of the maxilla by means of a Le Fort I osteotomy is a, widely used, procedure to correct dentofacial deformities. Maxillary intrusion, especially, is known to cause unwanted side effects on the orofacial soft tissues, such as broadening of the alar base, loss of vermilion show of the upper lip and down sloping of the commissures. This is likely to be caused by the detachment of the paranasal musculature. In order to get access to the maxilla, to carry out an osteotomy, a vestibular incision has to be made, which also cuts through the attachments on the premaxilla of the perioral muscles. In addition, degloving has to be done to free the paranasal area. This will sever the origins and insertions of parts of the paranasal and perioral muscles. The detached muscles will have a tendency to contract. When, after the osteotomy, the incisions are closed by means of a simple running suture, i.e. through the mucosa only, the detached and contracted muscles are not in their original position and most likely will re-insert at a higher, more lateral, position. To counteract the above unwanted effects, repositioning of the muscles involved, is recommended. This might not only have a beneficial effect on facial harmony, but might also improve the dynamics of the perioral muscles. In the present study the effect on nasolabial esthetics and dynamics (smile) of repositioning of the paranasal and perioral muscles (modified alar cinch sutures and V-Y closure) is compared to non-restoration of the detached muscles (simple closing sutures), both after Le Fort I osteotomies. This was done using standardized full facial frontal photographs. The nasolabial dynamics of patients with a frontal open bite deformity are, before the Le Fort I operation, significantly less in comparison to the dynamics of healthy volunteers. After the osteotomy, combined with alar cinch sutures and V-Y closure, the nasolabial dynamics were equal to the control group. After simple closing sutures, however, the dynamics remain significantly less in comparison to the control group. The nasolabial profile improves also after alar cinch sutures, combined with V-Y closure, as compared to simple closing sutures. Muscle repositioning by means of alar cinch sutures, combined with V-Y closure, is, therefore, recommended for Le Fort I osteotomie