Lateral osteotomies in rhinoplasty: a safer and less traumatic method.

Abstract

Osteotomies are required to mobilize the bony pyramid for infracture, outfracture, or realignment. Using traditional techniques and instruments, mobilization of the bony pyramid often results in serious edema and ecchymosis. The authors evaluate how the use of micro-osteotomes in lateral osteotomy influence postoperative healing. A series of 36 rhinoplasties were evaluated to determine the postoperative effect on edema and ecchymosis of micro-osteotomes used in the lateral osteotomy. In the last stage of the operation, right lateral osteotomy was performed with a 2-mm, V-shaped osteotome and left lateral osteotomy with a 4-mm straight Cottle osteotome. Patients were assessed based on postoperative photos taken after 24 and 48 hours. There was a marked reduction in edema and ecchymosis in the micro-osteotome series compared with the series in which a 4-mm straight Cottle osteotome was used. 2-mm V-shaped osteotomes reduce postoperative edema and ecchymosis and can be maneuvered cephalically to the medial oblique osteotomy with the best cosmetic results.