Lateral nasal osteotomy: a comparative study between the use of osteotome and a diamond surgical burr - a cadaver study

Abstract

BackgroundThe ultimate goal of rhinoplasty is to achieve a controllable, reliable and an aesthetically pleasing result. Various approaches and instruments have been introduced for the correction of the bony walls of the nose to improve predictability of the procedure and to minimize the associated trauma. We conducted a cadaveric study comparing the results of osteotomy of the nasal wall using a diamond surgical burr with those using a 2-mm osteotome.Material and methodsBilateral osteotomy of the nasal wall was performed on 10 cadavers. The 20 lateral nasal osteotomies were carried out on 7 females and 3 males of an age range between 61-91 years. A 2-mm osteotome was used percutaneously to perforate the lateral nasal wall of the right side. On the left side a 2-mm diamond surgical burr was introduced via an intraoral approach to thin out the lateral nasal wall. The in-fracture of the nasal bone was accomplished by controlled finger pressure. The nasal mucosa was inspected endoscopically and also dissected to identify any perforations or lacerations. The pattern of nasal fracture and the presence of any fragmentation of the bony segments were assessed clinically.ResultsThe in-fracturing of the nasal bone was accomplished by gentle pressure on the left side, but required more force on the contra lateral side. On the left side the in-fractured lateral nasal wall remained as one piece and no irregularities were seen. On the right side 3-5 bony fragments of irregular sizes and shapes were detected. There were 3-4 tears of the nasal mucosa, where the osteotome was applied. However, no mucosal tears were detected at the side, where the surgical burr was used.ConclusionOsteotomy of the lateral nasal wall with a diamond burr via intraoral approach is more precise and associated with fewer complications in comparison with the use of the osteotome.

A FEA-Based Methodology to Predict the Osteotome Wear Status during Nasal Bone Surgical Operations

“…A lateral nasal osteotomy should be precise, reproducible and avoid irregular fragmentation of the nasal bone [7,13]. Although the surgeon's experience and nasal bone anatomy are factors that need to be considered for obtaining the desired aesthetic outcome and for avoiding postoperative Figure 12c illustrates a characteristic fracture of the cutting edge of a straight osteotome that was clinically used after~100 impacts.…”

“…A lateral nasal osteotomy should be precise, reproducible and avoid irregular fragmentation of the nasal bone [7,13]. Although the surgeon's experience and nasal bone anatomy are factors that need to be considered for obtaining the desired aesthetic outcome and for avoiding postoperative complications, the choice of proper surgical technique and accurate osteotome is considered a more crucial factor by many surgeons [7,8]. Many studies have compared the different techniques of nasal osteotomies in terms of edema and postoperative ecchymosis [7,29].…”

“…Although the surgeon's experience and nasal bone anatomy are factors that need to be considered for obtaining the desired aesthetic outcome and for avoiding postoperative complications, the choice of proper surgical technique and accurate osteotome is considered a more crucial factor by many surgeons [7,8]. Many studies have compared the different techniques of nasal osteotomies in terms of edema and postoperative ecchymosis [7,29]. Other studies refer to predictability of fracture lines [29,30], prevention of the collapse of the nasal bones and prediction of the different fracture patterns of the nasal bone [4,5,31].…”

“…It should be mentioned that FEM analysis of surgical instruments used in rhinoplasty has been given little attention by researchers, in contrast to the biomechanical analysis of the nose. Ghassemi et al [7] have compared a diamond instrument with a curved osteotome for performing a lateral nasal osteotomy in a clinical study. However, there was no accompanying FEM study, whereas the quality of the osteotomy was checked only visually.…”

Minimally Invasive Technique In Correcting Crooked Nose

“…The method should be reproducible, safe, precise and do not cause irregularities of the lateral nasal wall. 4 It is essential that surgeons must detect and discuss the presence of preexisting facial asymmetry which important for both patient education and surgical planning. 5 The judicious use of anthropometric measurements and esthetic standards, together with the surgeon's perception, may be useful in the evaluation of facial asymmetry.…”