New advance in Nasal osteotomy

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New advance in Nasal osteotomy

• Babak Saedi
• Associate Professor
• Tehran University of Medical sciences
• Dr.babaksaedi.com

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Bony Anatomy
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Lateral Osteotomy

• Access for the osteotomy Short stab incisions
  just anterior to anterior attachment of the
  anterior turbinate Directed deep and laterally
  toward the bony piriform aperture
• /- subperiosteal tunnels for osteotome

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Sweeping osteotomies

• Typically the osteotomy is created in a
  high-low-high fashion. performing the osteotomy
  high along the pyriform aperture, low along the
  ascending maxilla, and then high again along
  superiorly along the nasal bones.
• For extra wide nasal bones, a low to high
  osteotomy will cause further narrowing of the
  facial width caudally.

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A perforating osteotomy

• Asmaller osteotome (2.0 mm) will provide
  perforations along the ascending maxilla
  superiorly
• A 2.0 mm osteotome is tapped once through the
  soft tissue envelope of the nasal tissues.
  Controlled perforating fractures are then placed
  along the nasal bones.
• The percutaneous approach has been shown to have
  increased ecchymosis on the second day versus
  continuous internal techniques

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Wide Nasal Bones

• Most of the time, lateral and medial osteotomies
  are sufficient for narrowing of both the nasal
  and facial width of the nasal bones.
• Excessively wide nasal width will sometimes
  require excision of a portion of medial nasal
  bone to allow for appropriate narrowing of the
  nasal bridge.
• Median osteotomy

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Crooked nose

• The crooked nasal bony pyramid requires a
  cogitative approach from the surgeon.
• Most deviated nasal bones can be straightened by
  osteotomies.
• If there is an asymmetric facial width, creating
  a discrepancy in slant height, a unilateral
  intermediate osteotomy should be considered.
• If the slant height discrepancy is large, the
  surgeon should consider excision of nasal bone to
  provide a more equivalent slant height.

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perforating methods

• It allows great precision in the placement of the
  osteotomy,
• The narrowing does not affect the nasal valve or
  compromise it.
• The external percutaneous approach may also be
  used to make intermediate transverse osteotomies
• it can be used to straighten sharply curved nasal
  bones.

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The lateral nasal osteotomy in rhinoplasty an
anatomic endoscopic comparison of the external
versus the internal approach.

• This anatomic study confirms our clinical
  experience that the external perforated osteotomy
  results in a more controlled fracture with less
  intranasal trauma
• Plast Reconstr Surg. 1997 Apr99(5)1309-12
  discussion 1313.
• Rohrich RJ, Minoli JJ, Adams WP, Hollier LH.

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Nasal osteotomies a clinical comparison of the
perforating methods versus the continuous
technique..

• the perforating internal method gave better
  results than the perforating external method
  (group C), neither of these differences was
  significant by either testing method.
• Plast Reconstr Surg. 2004 Apr 15113(5)1445-56
  discussion 1457-8.Gryskiewicz JM, Gryskiewicz KM

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Scars after external osteotomy

• The external osteotomy procedure produces an
  excellent cosmetic result at the puncture sites
  in the skin.

Visibility of Puncture Sites After External
Osteotomy in Rhinoplastic Surgery.
Arch Facial Plast Surg. 20035408-411
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Difference between external and internal
osteotomy out come

• Both the continuous and perforating osteotomy
  technique resulted in a decrease in the ventral
• nasal bone width.
• No statistical difference was found between
  continuous and perforating osteotomy techniques
  in the amount of nasal bone narrowing
• Quantitative Comparison Between Microperforating
  Osteotomies and Continuous Lateral Osteotomies in
  Rhinoplasty Arch Facial Plast Surg.
  201012(2)92-96

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Postoperative volume increase of facial soft
tissue after percutaneous versus endonasal
osteotomy technique in rhinoplasty using 3D
stereophotogrammetry

• No difference concerning swelling is found
  between the percutaneous and endonasal osteotomy
  technique sides. With 3D stereophotogrammetry
  volumetric data can be acquired and compared to
  evaluate soft-tissue changes
• Rhinology, 49, 121-126, 2011

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.Does creating a subperiosteal tunnel influence
the periorbital edema and ecchymosis in
rhinoplasty?

• Creating subperiosteal tunnels before lateral
  osteotomy statistically increased periorbital
  ecchymosis. Although there was no statistically
  significant difference, creating subperiosteal
  tunnels also increased development and severity
  of subconjunctival ecchymosis and edema.
• J Oral Maxillofac Surg. 2005 Aug63(8)1088-90

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complications
immediate Delayed
edema cellulitis
bleeding Nasal cyst formation
ecchymosis anosmia
hematoma Epiphora
Stair step deformity Rocker deformity
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The Effect of Lateral Osteotomy of
Septorhinoplasty on NasolacrimalDuct Functions
A Radionuclide Imaging Study

• There were not any permanent obstructions after
  lateral osteotomy of rhinoplasty. Temporary
  obstructions in the 1st postoperative week
  improved to normal preoperative status by the
  postoperative 3rd month.
• American Journal of Rhinology 19, 388394, 2005)