Lateral nasal osteotomies: Implications of bony thickness on fracture patterns

Precise lateral nasal osteotomies combined with digital greenstick infractu re can be a key feature in determining the success of a rhinoplasty procedu re. This procedure may be difficult to perform consistently because the sur geon relies on tactile cues transmitted through intact soft tissue. In 17 c adavers with known demographics, bone fracture patterns after lateral osteo tomy and digital greenstick infracture were studied and compared with measu red lateral bone pyramid thicknesses. One side of each nose served to measu re lateral wall thicknesses by drilling holes in a grid pattern and taking depth gauge measurements. Contralaterally, lateral osteotomy with digital g reenstick infractures were performed. Consistent patterns of bone thickness were found. Bone was thinner near the pyriform aperture with a high fragme ntation rate after osteotomy, Cephalocaudal thinning of the lateral bony py ramid near the medial canthus corresponded to the zone of greenstick fractu re in 14 of 14 noses. Two major fracture pattern groups were noted. When la teral osteotomy was taken to the level of the medial canthus vertically, th e greenstick fracture was consistent and predictable based on the transitio n in bone thickness from the radix area down across the lateral bony vault in untraumatized white cadavers.