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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (4): 736-742. doi: 10.19723/j.issn.1671-167X.2023.04.027

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Effect of alar base cinch suture based on anatomic landmarks on the morphology of nasolabial region in patients after orthognathic surgery

Wen ZHANG,Xiao-jing LIU,Zi-li LI*(),Yi ZHANG   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2020-10-09 Online:2023-08-18 Published:2023-08-03
  • Contact: Zi-li LI E-mail:kqlzl@sina.com

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Abstract:

Objective: To study the effect of a modified alar base cinch suture (ABCS) based on nasal musculature anatomy on the three-dimensional morphology of nasolabial region in patients after Le Fort Ⅰ osteotomy. Methods: In the study, 30 patients[11 males and 19 females, with an average age of (23.23±2.98) years]with skeletal Class Ⅲ malocclusion underwent orthognathic surgery between August, 2019 and January, 2020 to have the maxilla advanced no more than 4 mm in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology were involved and were divided into the test and control groups based on the random number table.In the test group, the nasal musculature was identified and labeled before dissection and the ABCS was according to the label, while in the control group, the nasal musculature was directly sutured and knotted in the midline of nose without prepend labeling.All the patients underwent three-dimensional facial photos preoperatively and 6 months postoperatively by using 3dMD face system.On the three dimensional image, soft tissue landmarks of nasolabial region was identified by the same examiner.Fourteen measurements including straight distance, curve distance, angle and ratio were measured.Statistical analysis was done by using SPSS 22.0. Results: There were significant differences between the two groups in cutaneous height of upper lip (P=0.023) and in nasal tip protrusion-alar width (P=0.012).The increase rate of cutaneous height of upper lip and the decrease rate of nasal tip protrusion-alar width in the control group were significantly higher than that in the test group.The alar width and alar base width of the both groups were significantly increased compared with the preoperative level (P < 0.05).The nasolabial angle in the control group was significantly higher compared with the normal value, while there was no significant difference between the test group and the normal value. Conclusion: Compared with the conventional suture method, this modified alar base cinch suture is more favorable for the postoperative nasal coordination and nasolabial morphology in patients who need mild to moderate maxillary advancement, and it has certain advantages in operability and objective accuracy.So it could become a modified and accurate method of alar base cinch suture and be widely applied in clinical practice.

Key words: Alar base cinch suture, Three-dimensional imaging, Anatomic landmarks, Le Fort Ⅰ osteotomy, Orthognathic surgical procedures

CLC Number: 

  • R782.2

Figure 1

The nasal musculature labeled and apposition suture A, identified the nasal musculature before cutting; B, labled the muscles; C, apposition suture after fixation; D, after suturing."

Figure 2

The nasal musculature sutured directly without prepend labeling A, use forceps to drag the nasal muscles; B, suture and knot in the midline of nose."

Figure 3

Measurements indicators of nasolabal soft tissue 1, inter-canthal distance; 2, nasal height; 3, nasal length; 4, nasal tip protrusion; 5, alar width; 6, alar base width; 7, columellar length; 8, cutaneous height of upper lip; 9, upper lip height; 10, crista philtri width; 11, nasolabial angle; 12, nasal tip angle; 13, facial prominence."

Table 1

Landmarks and measurements in the assessment of 3D nasolabial soft tissue changes"

Parameter Anthropometric landmarks
(1) inter-canthal distance R en-L en
(2) nasal height n-sn
(3) nasal length n-prn
(4) nasal tip protrusion prn-sn
(5) alar width R al-L al
(6) alar base width R alB-L alB
(7) columellar length sn-c
(8) cutaneous height of upper lip sn-ls
(9) upper lip height sn-sto
(10) crista philtri width R cph-L cph
(11) nasolabial angle c-sn-ls
(12) nasal tip angle n-prn-sn
(13) facial prominence n-prn-pg
(14) nasal tip protrusion-alar width ratio prn-sn/R al-L al

Table 2

Intra-group differences in nasolabial changes in the both groups (paired t test)"

ItemsTest group Control group
T1-T0, $\bar x \pm s$ P value T1-T0, $\bar x \pm s$ P value
(1) inter-canthal distance/mm 0.36±1.19 0.260 -0.36±0.86 0.124
(2) nasal height/mm -0.10±1.65 0.820 -0.72±1.67 0.119
(3) nasal length/mm -0.73±1.24 0.039* -1.01±1.56 0.025*
(4) nasal tip protrusion/mm 0.15±2.21 0.791 -0.78±1.26 0.031*
(5) alar width/mm 1.00±1.19 0.006* 1.23±1.59 0.010*
(6) alar base width/mm 0.73±1.29 0.045* 1.44±1.62 0.004*
(7) columellar length/mm -0.45±1.09 0.134 -0.14±1.15 0.646
(8) cutaneous height of upper lip/mm 0.46±1.07 0.121 0.96±0.82 0.001*
(9) upper lip height/mm 1.23±2.10 0.091 1.27±2.66 0.085
(10) crista philtri width/mm 0.16±1.79 0.701 0.39±1.04 0.731
(11) nasolabial angle/(°) 6.21±8.50 0.013* 3.79±7.90 0.085
(12) nasal tip angle/(°) 2.09±4.98 0.126 2.36±3.36 0.057
(13) facial prominence/(°) -4.71±3.05 < 0.001* -6.05±3.10 < 0.001*
(14) nasal tip protrusion-alar width ratio 0.018±0.053 0.218 -0.028±0.041 0.020*

Table 3

Inter-group differences in nasolabial change rates (group t test)"

Items Test group change rate/%, $\bar x \pm s$ Control group change rate/%, $\bar x \pm s$ P value
(1) inter-canthal distance 1.007±3.331 -1.010±2.360 0.066
(3) nasal length -1.547±2.746 -2.194±3.636 0.587
(5) alar width 2.594±3.149 3.534±4.595 0.519
(6) alar base width 3.239±6.875 7.283±8.984 0.177
(8) cutaneous height of upper lip 2.275±5.968 7.420±5.716 0.023*
(10) crista philtri width 2.927±14.393 9.236±8.647 0.157
(14) nasal tip protrusion-alar width ratio 4.313±11.404 -5.793±8.898 0.012*

Table 4

Nasolabial measurement differences between the two groups and the normal youth of the Han nationality (single t test)"

Items Normal, $\bar x \pm s$Test group Control group
T1, $\bar x \pm s$ P value T1, $\bar x \pm s$ P value
Nasal tip angle/(°) 105.70±9.78 103.71±8.12 0.358 106.78±5.81 0.483
Nasolabial angle/(°) 100.10±10.03 101.82±9.02 0.101 105.07±8.28 0.036*
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