Nasal sill resection concomitant with maxillary orthognathic surgery for the management of alar base widening

Alar base widening is a common soft tissue change following Le Fort I osteotomy. Although alar cinch sutures are commonly used to limit this change, their long-term stability remains variable. Nasal sill resection may provide a direct resective option for managing horizontal excess at the alar base; however, its use concomitantly with maxillary orthognathic surgery has not been well described. This retrospective clinical series aimed to describe longitudinal nasal base width changes and patient-reported aesthetic outcomes following nasal sill resection performed concomitantly with maxillary orthognathic surgery.

Twenty-three patients who underwent nasal sill resection concomitantly with maxillary orthognathic surgery under submental intubation between 2018 and 2020 were included. Alar base width was measured from the right and left alar curvature points to the subnasale/midcolumellar point, and total nasal base width was calculated as the sum of both measurements. Measurements were recorded preoperatively (T0), following osteotomy and fixation (T1), following nasal sill resection (T2), and at 1, 3, 6, and 12 months postoperatively. The Rhinoplasty Outcome Evaluation (ROE) questionnaire was administered preoperatively and at 6 and 12 months postoperatively. Repeated measures analyses with Bonferroni correction were used for longitudinal comparisons, and intra-observer reliability was assessed using the intraclass correlation coefficient.

The mean preoperative total nasal base width was 39.56 ± 3.12 mm. Following osteotomy and fixation, total nasal base width increased to 47.87 ± 3.64 mm, and after nasal sill resection it decreased to 30.78 ± 2.95 mm. Nasal base width gradually increased during follow-up, reaching 36.61 ± 5.96 mm at 12 months. Although the 12-month value was descriptively lower than the preoperative baseline, this difference was not statistically significant after Bonferroni correction (p = 0.693). ROE scores improved from 10.91 ± 2.68 preoperatively to 17.78 ± 2.54 at 6 months and 18.09 ± 2.27 at 12 months (p < 0.001), with no statistically meaningful difference between the 6- and 12-month follow-ups. No major adverse outcomes related to nasal sill resection were documented during the 12-month follow-up period.

In this retrospective clinical series, nasal sill resection performed concomitantly with maxillary orthognathic surgery was associated with maintenance of nasal base width close to the preoperative baseline at 12 months, despite an initial postoperative narrowing. Patient-reported nasal aesthetic scores improved during follow-up. However, because of the uncontrolled retrospective design, limited sample size, and absence of objective functional assessment, these findings should be interpreted as descriptive clinical observations and should be further investigated in prospective controlled studies.