Le Fort; I Clinical Trial
Official title:
Three Dimensional Evaluation of Nasolabial Changes Following Classic Versus Modified Alar Base Suture After Le Fort I Osteotomy
Three dimensional evaluation of nasolabial changes following classic versus modified alar cinch suture after Le Fort I osteotomy using cone beam computed tomography
Intra operative procedures: (For all groups) All surgical operations will be performed or
supervised by one of the authors (MdK). Intraoperative antibiotics will be given(1000 mg
cefazolin and 500 mg metronidazole). After nasotracheal intubation, the mucobuccal fold of
the maxilla will be infiltrated with local anaesthetic (articaine ; Ultracain DS Forte). The
Le Fort I procedure will be started with an incision in the gingivobuccal sulcus from the
canine on the one side to the canine on the other side. After elevation of the mucoperiosteum
and nasal mucosa, the osteotomy line will be designed with a fine burr, after which the cut
will be made with a reciprocal saw. The lateral nasal walls and nasal septum will be
osteotomized with a nasal osteotome. The piriform aperture and when necessary the nasal spine
will be rounded off. After mobilization of the maxilla, it will be positioned in the planned
position using an acrylic wafer. Fixation will be performed with four 1.5-mm miniplates, one
paranasal and one on the buttress on each side. The mucosa will be closed with a 4-0 Vicryl
suture (Ethicon ; Johnson and Johnson Medical, Norderstedt, Germany).
The alar cinch procedure will be performed through the intraoral incision as follows:
In the comparator ( control ) group:
The classic method of alar cinching will be performed in the following manner: An index
finger will be used to apply extraoral pressure on the alar base region, and a dentate
forceps will grasp this tissue through the intraoral incision. A suture bite will be taken at
this point through the tissue previously held by the forceps. The same procedure will be
applied on the opposite side. After passing the suture on both sides, it will be tightened
with attention to the alar base response. If the alar base suture will be judged to be
adequate, the vestibular incision will then be closed in a routine fashion, with or without
performing a V-Y lip closure.
In the intervention group:
The alar base will be marked with 3 landmarks: the nasofacial skin fold at the left alar base
(point LAB), the middle of the columella (point C), and the nasofacial skin fold at the right
alar base (point RAB). A needle will be inserted through the skin at the nasofacial skin fold
and exited through the fibroareolar tissue. A nonabsorbable suture without a needle will be
inserted through the needle from the oral cavity to the outside. The needle will be retracted
through point RAB without leaving the skin point, then returned to the oral cavity in a
medial position. Finally the needle will be retracted from point RAB, leaving the suture
through the soft tissue. The same procedure will be repeated on the other side. The 2 free
ends of the sutures will be then tied together after passing through a hole made in the nasal
spine.
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