Postoperative nostril asymmetry after Le Fort I osteotomy: an analysis of the interplay between alar cinch sutures and intubation side

BACKGROUND: Orthognathic surgery aims to improve jaw function and facial aesthetics through bilateral sagittal split osteotomy and Le Fort I osteotomy. Recent treatment goals emphasize careful evaluation of aesthetic outcomes, particularly in the nasolabial area, as repositioning the upper jaw can lead to significant soft tissue changes. This study investigates whether nasotracheal intubation affects nostril symmetry in patients undergoing Le Fort I osteotomy with/without cinch sutures. METHODS: A retrospective analysis of adult patients (ages 18-30, ASA I-II) who underwent Le Fort I surgery with nasotracheal intubation at Erciyes University from 2012 to 2020 was conducted. Preoperative and at six months postoperative, 3D images were analyzed to measure nostril width (NW). Patients were categorized into Group I (with cinch sutures) and Group II (without cinch sutures). Soft tissue changes were assessed using the 3dMD imaging system. RESULTS: Eighty-five patients were included. Significant changes in nostril width were observed between preoperative and six-month postoperative assessments in both groups. Right intubation led to increased right nostril diameter in both groups, while the left nostril showed significant change only in the cinch group. For left intubation, no significant changes were observed in nostril dimensions in the cinched group. The findings indicate that intubation side significantly influences nostril symmetry, particularly in cases of right nasotracheal intubation. The use of cinch sutures does not fully mitigate the widening effect, suggesting that the timing of cinch suture placement may be crucial. CONCLUSION: This study demonstrates that the nasotracheal intubation side may influence postoperative nostril width following Le Fort I osteotomy, particularly in patients receiving alar cinch sutures. The findings suggest that the physical presence of a nasotracheal tube during wound closure could interfere with the accurate assessment of alar base width.