External osteotomy in rhinoplasty

Objectives: To compare external and internal lateral osteotomy in rhinoplas ty, Study Design: Retrospective review and study on cadavers, Methods: One hundred forty-two patients who underwent aesthetic rhinoplasty were examine d. The following criteria were taken into consideration: edema and ecchymos is around the eyes, the degree of closure of the roof, symmetry and level o f fractures, solidity of the bone pyramid, and any scarring at the access p oint of the osteotome. In the last 25 patients who had surgery, a nasal end oscopy with optical fibers was carried out to evaluate any damage to the mu cosa caused by the 2-mm osteotome, Furthermore, to compare the two routes i n vivo, for five of these patients a lateral osteotomy was carried out exte rnally for one side and internally for the other. Lateral osteotomy were pe rformed on five cadavers by an external route on one side and by an interna l one on the other. A midface degloving procedure was performed to expose t he osteotomy sites, Results: Edema and ecchymosis were always much less sev ere in patients who were treated with external osteotomy, The control of th e fracture line was always excellent, Endoscopic evaluation and study on ca davers revealed damages to the mucosa caused from the internal osteotomy an d a better control of fracture line in external osteotomy, Conclusions: Ext ernal osteotomy is an easy and precise approach. Because the fracture is of a greenstick type, the bone stumps are stable, The reduced bleeding reduce s the formation of edemas and ecchymosis around the eyes. The damage to the nasal mucosa is minimal, and the cutaneous scars are virtually invisible a month after surgery.