Online Contents
Animations
As the Dorsal Hump is Removed, a Square Shaped Dorsum will Result Animation 5.1A , B
The Upper Lateral Cartilage is Repositioned Animation 5.2
Pearls
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As the osteotomy is completed and the nasal bones are medialized, if the anterior portion of the inferior turbinate extends anterior to the plane of the osteotomy, it will be medialized as well.
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On patients who have an anteriorly positioned turbinate, the lateral osteotomy can be high-to-low rather than low-to-low to minimize the ill effects on the airway.
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As the nasal bone is medialized, it will reposition the upper lateral cartilage medially. The longer the nasal bone, the more influence it will have on the upper lateral cartilage.
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If the medialization of the inferior turbinate is recognized intraoperatively, the protruding portion of the inferior turbinate can be reduced conservatively.
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It is important to complete the lateral portion of the wedge osteotomy first. Otherwise, if the osteotomy on the medial portion of the wedge is completed first and the nasal bone becomes unstable, it will be very difficult, if not impossible, to complete the lateral portion of the wedge osteotomy.
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Using lateral osteotomy without medial or cephalic osteotomy can result in an unfavorable fracture extending through the least resistant portion of the lateral nasal wall, causing irregularities anteriorly.
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When a low-to-high osteotomy is performed, one may see or palpate a step deformity or grooving of the nasal bone which is aesthetically displeasing.
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To eliminate the grooving secondary to an anteriorly positioned osteotomy (low-to-high), a second osteotomy is necessary posteriorly to reposition the residual lateral segment of the bone.
One of the most consequential maneuvers in rhinoplasty is nasal bone osteotomy, the importance of which has not been sufficiently emphasized. An improper, and even a proper, osteotomy can result in some adverse effects, avoidance of which can make the rhinoplasty much more successful. The technique of nasal bone osteotomy was discussed in Chapter 4 . In this chapter, we will discuss the consequences of the nasal bone osteotomy and the nuances that make a difference in the final outcome.
Almost any time a large hump is removed, an osteotomy becomes mandatory to avoid excess width of the dorsum. This may not be clear during the initial observation of the patient’s nose. In fact, there are noses that appear too narrow and one can only recognize the need for osteotomy with the aid of foresight. Palpation of the nasofacial junction can help in this regard and can lead the surgeon to the conclusion that after removal of a narrow dorsal hump an osteotomy will be unavoidable. Removal of a large dorsal hump will often result in an open roof with a square and wide dorsal configuration ( Figure 5.1 ; Animation 5.1). Every effort should be made to maintain the integrity of the mucoperiosteum along the roof of the nose, which can be valuable in controlling the dorsal width. The choice of the osteotomy will be dictated by a variety of factors, which will be discussed later in this chapter.
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