Nasal Osteotomies: A Clinical Comparison of the Perforating Methods versus the Continuous Technique

Abstract

Do perforating lateral osteotomies cause less ecchymosis and edema compared with the popular continuous method? Many studies have demonstrated that perforated osteotomies cause less trauma and periosteal disruption. Numerous investigators have subjectively perceived less postoperative ecchymosis and edema, but no clinical study has compared the perforated methods versus the continuous technique in the same patient. This prospective, randomized, partially blinded study was designed to test the hypothesis that the perforating method causes less postoperative ecchymosis and edema compared with the continuous lateral osteotomy technique. The questions remain: does the type of perforating osteotomy affect the results? Does a percutaneous approach cause more ecchymosis and edema by the access maneuver of piercing the skin? The two perforating lateral nasal osteotomy techniques require the same 2-mm straight osteotome, so any genuine difference in postoperative ecchymosis or edema could only be attributed to the differing surgical approaches. Accordingly, this study also tests whether the external percutaneous perforating osteotomy causes more ecchymosis and edema than the internal transnasal perforating method. Twenty-five consecutive rhinoplasty patients (group A) requiring bilateral osteotomies (50 total lateral osteotomies) were randomized so that each patient received an internal/transnasal perforating lateral osteotomy (2-mm straight chisel) on one side and an internal/transnasal continuous osteotomy (4-mm curved, guarded osteotome) on the other. The next 25 patients studied (group B) received an external/percutaneous perforating lateral osteotomy (same 2-mm straight chisel as used in group A) on one side and the same internal/transnasal continuous osteotomy on the other. The final 25 consecutive rhinoplasty patients (group C) received an external percutaneous perforating lateral osteotomy on one side and an internal transnasal perforating lateral osteotomy on the other. The entry sites for the perforating osteotomies were either external (groups B and C) with a percutaneous skin puncture or intranasal (groups A and C) at the pyriform aperture. All 75 patients (150 total lateral osteotomies) initialed the surgical plan on the Gunter rhinoplasty worksheet, which has been approved by the Institutional Review Board of Abbott-Northwestern Hospital, Minneapolis, Minnesota (study no. 1341-1 M). All patients were evaluated for ecchymosis and edema on the left versus the right side of the face at 2 to 3, 7, and 21 days after the operation. The clinical evaluation was performed by two blinded examiners (clinic registered nurse and the patient with his or her family) and a partially blinded examiner (the surgeon, who did not refresh his memory about the randomization). To compare the two methods in each study (groups A, B, and C) for the six outcomes (edema and ecchymosis at 2 to 3, 7, and 21 days), the authors used an exact binomial test of the null hypothesis that the treatments do not differ. To compare the two methods i...

External vs. internal osteotomy in rhinoplasty

“…Our findings suggest the same. Gryskiewicz and Gryskiewicz (12) carried out lateral osteotomy in 50 patients (25 perforating lateral osteotomy and 25 continuous osteotomy) and found that perforating lateral osteotomy with 2 mm straight osteotome reduces postoperative ecchymosis and edema in rhinoplasty patients compared with continuous osteotomy (4 mm curved guarded osteotome) and concluded that use of perforating osteotomies should be encouraged than continuous osteotomies. Our findings were similar as above.…”

External osteotomy in rhinoplasty: Piezosurgery vs osteotome

“…Historically, two techniques have been used to facilitate lateral nasal osteotomy; the intranasal continuous method and the transcutaneous perforating method [3,[8][9][10]. Rohrich et al compared the two techniques in a cadaver study and the blinded endoscopic evaluation showed less intranasal trauma and minimal morbidity (hemorrhage, edema and ecchymosis) associated with the external approach [11,12].…”

Effects of lidocaine and adrenaline combination on postoperative edema and ecchymosis in rhinoplasty

“…These commonly occur as a result of lateral osteotomies during rhinoplasty. Different lateral osteotomy techniques have been described to reduce edema, ecchymosis and to achieve the best aesthetic results, including percutaneous and endonasal lateral osteotomies 6,22 . Other techniques used during the postoperative period include steroid administration (preoperative and/or postoperative), applying pressure on osteotomy sites and taping and periorbital cold pack application 5,10 .…”