Visible Perforating Lateral Osteotomy: Internal Perforating Technique with Wide Periosteal Dissection

There are two general categories of lateral osteotomy techniques—the external perforating method and the internal continuous method. Regardless of which technique is used, procedural effectiveness is hampered by limited visualization in the surgical field. Considering this point, we devised a new technique that involves using a wide subperiosteal dissection and internal perforation under direct visualization. Using an intranasal approach, whereby the visibility of the intended fracture line was maintained, enabled a greater degree of control, and in turn, results that were more precise, and thus predictable and reproducible. Traditionally, it has been taken as dogma that the periosteum must be preserved, considering the potential for dead space and bony instability; however, under sufficient visualization of the surgical field with an internal perforating method, complete osteotomy with fully preserved intranasal mucosa could be conducted exactly as intended. This intact mucosal lining compensates for the elevated periosteum. Compressive dressing and drainage through a Silastic angio-needle catheter enabled the elimination of dead space. Therefore, precise, reproducible, and predictable osteotomy minimizing the potential for associated complications such as ecchymosis, that is, bruising owing to hemorrhage, could be performed. In this article, we introduce a novel technique for lateral osteotomy with improved visualization.

Keywords

Rhinoplasty - Osteotomy - Ecchymosis - Dissection

This article was presented at the 71st International Congress of the Korean Society of Plastic and Reconstructive Surgeons, November 2, 2013 in Seoul, Korea.

Publication History

Received: 02 April 2015

Accepted: 19 October 2015

Article published online:
20 April 2022

• References

• 1 Rohrich RJ, Minoli JJ, Adams WP. et al. The lateral nasal osteotomy in rhinoplasty: an anatomic endoscopic comparison of the external versus the internal approach. Plast Reconstr Surg 1997; 99: 1309-1312 discussion 1313
• 2 Giacomarra V, Russolo M, Arnez ZM. et al. External osteotomy in rhinoplasty. Laryngoscope 2001; 111: 433-438
• 3 Gryskiewicz JM, Gryskiewicz KM. Nasal osteotomies: a clinical comparison of the perforating methods versus the continuous technique. Plast Reconstr Surg 2004; 113: 1445-1456 discussion 1457-8
• 4 Most SP, Murakami CS. A modern approach to nasal osteotomies. Facial Plast Surg Clin North Am 2005; 13: 85-92
• 5 Yucel OT. Which type of osteotomy for edema and ecchymosis: external or internal?. Ann Plast Surg 2005; 55: 587-590
• 6 Sinha V, Gupta D, More Y. et al. External vs. internal osteotomy in rhinoplasty. Indian J Otolaryngol Head Neck Surg 2007; 59: 9-12
• 7 Becker DG, McLaughlin Jr RB, Loevner LA. et al. The lateral osteotomy in rhinoplasty: clinical and radiographic rationale for osteotome selection. Plast Reconstr Surg 2000; 105: 1806-1816 discussion 1817-9
• 8 Cochran CS, Landecker A. Prevention and management of rhinoplasty complications. Plast Reconstr Surg 2008; 122: 60e-67e
• 9 Rettinger G. Risks and complications in rhinoplasty. GMS Curr Top Otorhinolaryngol Head Neck Surg 2007; 6: Doc08
• 10 Rohrich RJ, Janis JE, Adams WP. et al. An update on the lateral nasal osteotomy in rhinoplasty: an anatomic endoscopic comparison of the external versus the internal approach. Plast Reconstr Surg 2003; 111: 2461-2462 discussion 2463
• 11 Rohrich RJ, Krueger JK, Adams Jr WP. et al. Achieving consistency in the lateral nasal osteotomy during rhinoplasty: an external perforated technique. Plast Reconstr Surg 2001; 108: 2122-2130
• 12 Gryskiewicz JM. Visible scars from percutaneous osteotomies. Plast Reconstr Surg 2005; 116: 1771-1775
• 13 Ford CN, Battaglia DG, Gentry LR. Preservation of periosteal attachment in lateral osteotomy. Ann Plast Surg 1984; 13: 107-111
• 14 Lee YJ, Hong SH, Hong SE. Modified narrowing corrective rhinoplasty & augmention rhinoplasty in patient with wide nasal bone. J Korean Soc Plast Reconstr Surg 2005; 32: 37-42