The effect of alar cinch sutures and V-Y closure on soft tissue dynamics after Le Fort I intrusion osteotomies

Adverse effects on the soft tissues after Le Fort I osteotomies include: broadening of the alar base, loss of vermilion show of the upper lip and down sloping of the commissures. In theory, an alar cinch suture combined with a muco-musculo-periosteal V-Y closure (ACVY) should improve not only the nasal width, but would also improve the dynamics of some of the mimic muscles. To test the validity of this hypothesis, a prospective study was set up including 22 patients, using standardized full facial frontal photographs, taken immediately pre-operatively and 18 months postoperatively. Sets containing three pictures were made: soft tissue in repose, maximum closed mouth smile and maximum smile. The landmarks, alare, crista philtri and cheilion were analysed. The preliminary results show that ACVY-closure does significantly improve the horizontal movement of cheilion with both maximum closed mouth smile and maximum smile, as well as the vertical movement of crista philtri with maximum closed mouth smile. Conclusion: The Le Fort I osteotomy with ACVY improves the orofacial dynamics. (C) 2009 European Association for Cranio-Maxillofacial Surgery