Nayeem Ali

Use of the alar base cinch suture in Le Fort I osteotomy: is it effective?

The alar base cinch suture is often used to mitigate the unfavourable increase in nasal width after Le Fort I impaction or advancement of the maxilla. Recently a number of studies have looked at the stability and clinical outcome of this intervention. We investigated the effect of an alar base cinch suture on the change in width of the alar base after Le Fort I osteotomy using a three-dimensional imaging system. Twenty-eight patients were prospectively randomised into an intervention group where a cinch suture was used, and a control group. The width of the alar base was measured before operation, and then at one, and six months. At six months it had increased from baseline by a median of 2mm in all patients. The median increase was greater in the control group than in the cinch placement group, but the difference was small. The range in both groups was large, indicating great individual variability. There was an overall reduction in the width of the alar base between one and six months after operation, which indicated some resolution of soft tissue oedema associated with the operation, but the median reduction was small and unlikely to be clinically significant. The preliminary findings suggest that the suture confers little benefit in controlling the width of the alar base of the nose after Le Fort I osteotomy. More recently it has been suggested that procedures using a modified cinch suture may result in greater stability.

Incidence and impact of previous orthodontic treatment in patients attending orthognathic combined clinics: a survey.

This prospective questionnaire-based study was designed to determine the incidence of patients attending orthognathic combined clinics who have previously had orthodontic treatment, and to assess the impact, if any, this has had on their proposed surgical treatment. Contemporaneous and historical data from consecutive patients at different stages of treatment who were attending clinics at two London hospitals during a three-month period were included. In total 22/56 patients (39%) had previously had orthodontic treatment, and of those, it had had an undesirable effect on the current management of 10 (45%). The effects included a reduced range of dental movements available to orthodontists (8/23, 35%), undesirable extractions (5/23, 22%), and a prolonging of preoperative orthodontics (5/23, 22%). The median age at which previous orthodontic treatment had been started was 13.5 (range 11-26). Nearly a third of patients reported that they had not been advised by their referring practitioner that a combined orthodontic and surgical approach might be required. The study suggests that preliminary assessment should be improved. Patients should be informed about and prevented from undergoing orthodontic treatment that may limit future surgical management, otherwise they may have to face repeated and prolonged orthodontic treatment, unexpected operations, and potential limitations to the outcome of surgical treatment. This could be achieved through the training and education of all practitioners and the development of referral guidelines.