Lateral nasal osteotomy: a comparative study between the use of osteotome and a diamond surgical burr - a cadaver study

Abstract

Background: The ultimate goal of rhinoplasty is to achieve a controllable, reliable and an aesthetically pleasing result. Various approaches and instruments have been introduced for the correction of the bony walls of the nose to improve predictability of the procedure and to minimize the associated trauma. We conducted a cadaveric study comparing the results of osteotomy of the nasal wall using a diamond surgical burr with those using a 2-mm osteotome.

Material and methods: Bilateral osteotomy of the nasal wall was performed on 10 cadavers. The 20 lateral nasal osteotomies were carried out on 7 females and 3 males of an age range between 61-91 years. A 2-mm osteotome was used percutaneously to perforate the lateral nasal wall of the right side. On the left side a 2-mm diamond surgical burr was introduced via an intraoral approach to thin out the lateral nasal wall. The in-fracture of the nasal bone was accomplished by controlled finger pressure. The nasal mucosa was inspected endoscopically and also dissected to identify any perforations or lacerations. The pattern of nasal fracture and the presence of any fragmentation of the bony segments were assessed clinically.

Results: The in-fracturing of the nasal bone was accomplished by gentle pressure on the left side, but required more force on the contra lateral side. On the left side the in-fractured lateral nasal wall remained as one piece and no irregularities were seen. On the right side 3-5 bony fragments of irregular sizes and shapes were detected. There were 3-4 tears of the nasal mucosa, where the osteotome was applied. However, no mucosal tears were detected at the side, where the surgical burr was used.

Conclusion: Osteotomy of the lateral nasal wall with a diamond burr via intraoral approach is more precise and associated with fewer complications in comparison with the use of the osteotome.

Figure 1

On the left side the 2-mm osteotome and on the right side the 2-mm diamond burr used for lateral nasal osteotomy.

Figure 2

Frontal view of the performed osteotomies in fresh cadaver specimen performed on the right side with an osteotome and on the left side with diamond surgical burr.

Figure 3

Left lateral view of the nose of a fresh cadaver specimen showing a smooth contour of its course.

Figure 4

A formalin preserved cadaver nose showing absence of mucosal laceration or damage.

Figure 5

Right lateral view of the nose of a fresh cadaver specimen showing many irregular fragments along the course of the bone cut.

Figure 6

Perforation of the nasal mucosa along the osteotomy path as a result of use of osteotome for bone cut.