Abstract
Purpose
Lateral osteotomies are important during rhinoplasty and represent a challenging technique that otolaryngology and plastic surgery trainees must learn. The approaches for osteotomies are difficult to teach as they are accomplished through tactile feedback. Trends in teaching and practice patterns of lateral osteotomies are poorly described in the literature, and this study aims to fill this knowledge gap.
Materials and methods
Members of the American Academy of Facial Plastic and Reconstructive Surgery were surveyed to characterize surgeon preferences for intranasal versus percutaneous lateral osteotomies and understand how techniques are taught.
Results
Among surgeons who completed the survey (n = 172), 87% reported that they “always” or “mostly” use intranasal lateral osteotomies whereas only 8% “always” or “mostly” use percutaneous approaches. There is no significant trend towards changing osteotomy techniques when teaching trainees. Only 15% of respondents allow trainees to perform lateral osteotomies in more than half of operations.
Conclusions
Most facial plastic surgeons prefer to use intranasal lateral osteotomies. However, many do not allow trainees to perform this critical step during rhinoplasty. This study has implications for both patient care and surgical education.
1
Introduction
Lateral osteotomies are essential to functional and cosmetic rhinoplasties and can be performed through percutaneous or transnasal approaches. While some surgeons find a percutaneous approach enables a more controlled fracture and minimizes deep tissue trauma , others posit that an intranasal approach minimizes morbidity and avoids scarring . Both techniques are important, but difficult to teach, as they are performed through tactile feedback, although there is limited literature characterizing this problem. The complications of an incorrectly performed osteotomy include poor aesthetic results as well as poor functional outcomes. Incorrectly performed osteotomies are difficult to correct.
Given the difficulty inherent in teaching these surgical techniques, we sought to better characterize how lateral osteotomies are performed and taught nationwide. This study offers an up to date understanding of how osteotomies are currently performed by facial plastic surgeons and highlights areas for improvement in surgical education.
2
Methods
This project was approved by the Massachusetts Eye and Ear Infirmary institutional review board. A survey was designed using Qualtrics Software (Provo, UT) and distributed via e-mail by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) to ~1100 members between September and November 2015. Participation was voluntary and responses were anonymous. Survey data were analyzed with descriptive and analytic statistics using Graphpad Prism (La Jolla, CA) and multivariable regressions were performed using Wessa.net (online version 1.1.23-r7). Paired t -tests were used to determine if surgeons changed osteotomy technique when teaching trainees as compared to when operating alone. Multivariable regressions determined variables associated with type of osteotomy used in current practice and type of osteotomy taught. Chi-squared tests were used to determine if timing of training is independent from techniques learned during training.
2
Methods
This project was approved by the Massachusetts Eye and Ear Infirmary institutional review board. A survey was designed using Qualtrics Software (Provo, UT) and distributed via e-mail by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) to ~1100 members between September and November 2015. Participation was voluntary and responses were anonymous. Survey data were analyzed with descriptive and analytic statistics using Graphpad Prism (La Jolla, CA) and multivariable regressions were performed using Wessa.net (online version 1.1.23-r7). Paired t -tests were used to determine if surgeons changed osteotomy technique when teaching trainees as compared to when operating alone. Multivariable regressions determined variables associated with type of osteotomy used in current practice and type of osteotomy taught. Chi-squared tests were used to determine if timing of training is independent from techniques learned during training.
3
Results
One-hundred and seventy two surgeons completed the survey. The average respondent performs 21 to 50 rhinoplasties annually and completed surgical training 16.3 years ago (SD = 11, median = 14, Fig. 1 a, b ). 87% of respondents “always” or “mostly” perform intranasal lateral osteotomies while 8% “always” or “mostly” use percutaneous approaches ( Fig. 1 c). Similarly, 90% of respondents learned primarily to perform intranasal osteotomies during training ( Fig. 1 d). Notably, the proportion who received significant training in percutaneous techniques has significantly increased among those who finished training in the last 15 years compared with those who trained earlier (16% vs. 4%, Chi-square test for independence p = 0.01). The osteotomy approach preferred was associated with the type respondents learned during training (β = 0.54, SD = 0.13, p < 0.001), whereas years since training ( p = 0.45) and rhinoplasties performed annually ( p = 0.34) were not associated.
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