Perforating Osteotomies in Rhinoplasty

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].…”

“…There is still considerable debate over the optimal method and approach to perform lateral osteotomies. They may be carried out using an internal approach, through the nose or the mouth, or with an external percutaneous approach using a 2-mm wide osteotome [2,3]. Both approaches are widely practiced, and the surgeon's choice is generally based on his own preference and experience.…”

Mucous Cysts as a Complication of Rhinoplasty

“…They report better stability and more predictable outcomes with external perforated osteotomy, by using a small osteotome (2-4 mm) that simultaneously minimize disruption of periosteal surfaces, stabilize medial movement, reduce lateral wall collapse and decreases dead space. (Goldfarb et al, 1993;Rohrich et al, 2001;Rohrich et al, 2003) It as experimentally been shown that this technique decreases soft-tissue disruption or displacement compared to continuous osteotomies. (Byrne et al, 2003) It must also be emphasized that none of the reported postrhinoplasty cysts are connected to this surgical technique.…”

Indikationen und Techniken der Rhinoplastik

“…Wie bei sämtlichen rhinochirurgischen Eingriffen ist eine kontrollierte Senkung des Blutdrucks sowie eine Anti−Trendelenburg−Lage− rung sinnvoll. Da die laterale Osteotomie der traumatisierendste Schritt für die Gesichtsweichteile ist, sollte diese am Ende der Operation, unmittelbar vor dem Aufbringen der Schiene erfol− gen. Diese ¹logische Änderung" der Operationsschritte wurde bereits vor mehr als 40 Jahren empfohlen [5], und später vielfach wiederholt [123,128,140,148], jedoch auch heute nicht allge− mein eingehalten. Es erscheint plausibel, dass die 2 mm oder 3 mm breiten, flach angeschliffenen Mikro−Osteotome zu einer Verringerung der Schwellung beitragen.…”