| Objective:Orthognathic surgery mainly corrects dento-maxillofacial deformities by repositioning the jaws,so that the patient can obtain a good facial appearance.The maxillary surgery included by orthognathic surgery(especially Le Fort Ⅰ type osteotomy and advancement)can make the nasolabial sulcus to become shallow,the nasolabial region to widen,and the nasolabial region becomes flat.Among them,the most obvious change and the easiest to be noticed by patients is the increase in the width of the nose.This phenomenon leads to a decrease in postoperative satisfaction of patients and brings psychological distress to patients.Therefore,choosing a good method of suturing and fixing the nose to reshape the original width of the nose is the key to solving this problem.In this study,by measuring the patient’s nasal width index before and after orthognathic surgery,fully comparing and evaluating the postoperative effects of the three commonly used methods of nasal alar suture and fixation in clinic,it has reference significance for clinicians in the choice of methods.Methods:A total of 66 patients with dental and maxillofacial deformities who underwent maxillary Le Fort Ⅰ osteotomy and advancement in the Department of Oral and Maxillofacial Surgery of the Affiliated Stomatological Hospital of China Medical University from December 2018 to August 2020(the advancement distance is 3-5mm,All patients underwent anterior nasal ridge trimming,VY suture of the maxillary vestibular sulcus incision and fixation of the nasal septum)and were randomly divided into three groups.Group A:Traditional alar base cinch suture(ABCS),a total of 27 cases.Group B:ABCS was fixed in the anterior nasal spine,a total of 21 cases.Group C:ABCS was fixed at the lower edge of the piriform hole,a total of 18 cases.Collect the patient’s maxillofacial spiral CT data from 1-7 days before orthognathic surgery and 6 months or more after surgery.Use Proplan CMF 3.0 software to reconstruct the CT data into a soft tissue skull model,and mark the alar base point on the soft tissue skull model.)And the outer point of the alar(Al),measure the Sbal-Sbal and Al-Al distances on both sides before and after the operation,analyze the data,and evaluate the difference in the postoperative effects of the three methods of suture and fixation of the alar base.Use IBM SPSS Statistics 26.0 software for statistical analysis,use KS test method for normality test,use Levene test method for homogeneity of variance test,use paired-sample t test to compare the difference of preoperative and postoperative measurement values.The chi-square test was used to compare qualitative data,the analysis of variance was used to compare the measured values between multiple groups,and the LSD method was used to compare pairwise between groups to evaluate the differences in the effects of the three suture fixation methods.Results:After operation(≥6 months)compared with preoperative,the distance between the base points of the alar and the outer points of the alar after the operation were increased compared with that before the operation.The paired sample t-test results showed that the preoperative and postoperative corresponding index measurement values The difference between them is statistically significant.In group A,the distance between the base points of the nasal alar increased by(0.72±0.29)mm,and the distance between the outer points of the nasal alar increased by(0.91 ±0.24)mm.In group B,the distance between the base points of the nasal alar increased by(1.15±0.28)mm on average,and the distance between the outer points of the nasal alar increased by(1.32±0.31)mm on average.In group C,the distance between the base points of the nose alar increased by(1.99±0.39)mm,and the distance between the outer points of the nose alar increased by(2.12±0.21)mm.The results of analysis of variance showed that the changes in Sbal-Sbal and Al-A1 before and after the operation were not completely equal among the three groups(P<0.05).The multiple comparison(LSD)method was used for pairwise comparisons,and the results showed that the changes in Sbal-Sbal and Al-Al were statistically significant between group A and group B,group A and group C,and group B and group C(P<0.05).Conclusions:The postoperative effects of the three alar base sutures and fixation methods are different.The traditional alar base constriction suture has the best effect,and the alar base suture fixes the anterior nasal spine.The method has the worst effect.The narrowing effect of the three methods on the base point of the alar is better than the narrowing effect on the outer point of the alar.The width of the nasal alar after the three methods was increased compared with that before the operation. |
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