THE LATERAL NASAL OSTEOTOMY IN RHINOPLASTY - AN ANATOMIC ENDOSCOPIC COMPARISON OF THE EXTERNAL VERSUS THE INTERNAL APPROACH

A precise and reproducible lateral osteotomy is a requirement for succ essful rhinoplasty. Two basic techniques have evolved: the external pe rforated method and the internal continuous method. The literature sup porting the external perforated technique maintains that it contribute s to a controlled, stable fracture and produces less nasal airway narr owing, hemorrhage, edema, and ecchymosis; however, the continuous inte rnal method is used by many rhinoplasty surgeons. Our study was design ed to compare the two techniques in the fresh cadaver nose using a bli nded endoscopic evaluation of the nasal mucosa after the osteotomies w ere performed by one of these two techniques. Nineteen fresh cadaver h eads had an external perforated lateral osteotomy performed on one sid e and an internal continuous lateral osteotomy performed on the altern ate side by an investigator with experience in the use of both osteoto mies. In a blinded fashion, four different investigators used nasal en doscopy to detect mucosal perforations and bony irregularities. Eleven percent of the perforated osteotomies resulted in mucosal tearing as opposed to 74 percent of the continuous osteotomies (p < 0.001). This anatomic study confirms our clinical experience that the external perf orated osteotomy results in a more controlled fracture with less intra nasal trauma and can minimize the associated morbidity (hemorrhage, ed ema, and ecchymosis) in the rhinoplasty patient.