Internal Lateral Nasal Osteotomy: Double-Guarded Osteotome and Mucosa Tearing
- 17 September 2010
- journal article
- research article
- Published by Springer Nature in Aesthetic Plastic Surgery
- Vol. 35 (2), 171-176
- https://doi.org/10.1007/s00266-010-9577-8
Abstract
For the internal lateral nasal osteotomy, a 4-mm double-guarded straight osteotome that separates the external periost and mucoperiosteum while the osteotomy is progressing is presented. Before the osteotomy, the external periost and the internal mucoperiosteum are infiltrated with local anesthesia and elevated by tunneling with an elevator. As the sharp part is behind the guards, it is not possible for the osteotome to slip away laterally or medially from the nasal bone. By tunneling just at the base of the nasal bones, arteries, veins, and lymphatics are preserved while the superior part of the external periosteum and the internal mucoperichondrium maintained the bones in a stable position with firm support to both sides. Forty consecutive rhinoplasties were studied with an endoscope. In 35 primary rhinoplasties the mucosa laceration rate was 1.5%, whereas in secondary rhinoplasties it was 80%. The approach to the piriform aperture was intranasal in the first 16 cases and intraoral in the last 24 cases. The intraoral mucosal elevation and osteotomy were easier to carry out than in the intranasal approach. In general, minor lower-lid edema and ecchymosis were observed, possibly related to the fact that the periosteum was elevated, thus preserving the supraperiosteal arteries, veins, and lymphatics. When the mucosa was elevated, the internal irrigation of the mucosa and the lymphatics was also preserved, thus avoiding intraoperative bleeding, intranasal packing, and postoperative bleeding.Keywords
This publication has 9 references indexed in Scilit:
- Loop Drainage Tube for Reduction of Edema and Ecchymosis After RhinoplastyAesthetic Plastic Surgery, 2008
- Lateral Osteotomies in Rhinoplasty: A Safer and Less Traumatic MethodAesthetic Surgery Journal, 2008
- Lateral Nasal Osteotomies: Implications of Bony Thickness on Fracture PatternsAnnals of Plastic Surgery, 1999
- Nose surgery (rhinoplasty) without external immobilization and without internal packing: a review of 812 cases.Aesthetic Plastic Surgery, 1998
- The Lateral Nasal Osteotomy in Rhinoplasty: An Anatomic Endoscopic Comparison of the External versus the Internal ApproachPlastic and Reconstructive Surgery, 1997
- Comparison of four different types of osteotomes for lateral osteotomy: A cadaver studyAesthetic Plastic Surgery, 1996
- Steps for a safer method of osteotomies in rhinoplastyThe Laryngoscope, 1987
- Preservation of Periosteal Attachment in Lateral OsteotomyAnnals of Plastic Surgery, 1984
- Double Lateral Osteotomy in RhinoplastyJAMA Otolaryngology–Head & Neck Surgery, 1977