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Individualized nasal osteotomy can produce more aesthetically pleasing results

Individualized nasal osteotomy approaches can increase the predictability of surgical outcomes in patients undergoing rhinoplasty.

Researchers retrospectively reviewed the clinical outcomes of 150 patients who underwent rhinoplasty at private clinics between 2009 and 2011, examining the type and frequency of specific osteotomy procedures in addition to pre- and postoperative photographs.

Overall, 97 patients with least 12 months of follow-up were included in the final evaluation. Ninety-two of the patients received lateralized medical oblique osteotomy, 70 required bilateral intermediate osteotomy and 21 patients underwent unilateral osteotomy.

Among the base osteotomies performed, 41 patients (42%) underwent bilateral base osteotomy and 24 patients (25%) underwent unilateral base osteotomy. In 32 patients (33%) who had aesthetically pleasing lateral wall width and no convexity of the posterior part of the lateral bony wall, base osteotomy was not performed.

According to the researchers, osteotomies and their various sequences should be determined on an individual basis on each side of the nose, due to the fact that height, width and length variations in the osteocartilaginous vault can have significant influence over the shape and degree of asymmetry.

Based on their findings, the researchers developed a four-step analysis for each osteotomy performed, which includes an assessment of the desired dorsal width after dorsal reduction, during which time the widest point on the dorsal lines is located to determine whether a need for lateralized medial oblique osteotomy exists. The second step involves addressing lateral wall convexity, which determines the need for an intermediate osteotomy. Third, the researchers recommend an analysis of base bony width in relation to intercanthal width to determine the need for a lateral osteotomy. And finally, each side of the nose should be analyzed independently.

Overall, all nasal osteotomies should involve component-oriented and individualized surgical approaches, according to the researchers. – by Abigail Sutton

Disclosures: The researchers report no relevant financial disclosures.