External osteotomy in rhinoplasty = Zunanja osteotomija v rinoplastiki
Giacomarra, Vittorio ...
Lateral osteotomy is a fundamental step in rhinoplasty. It can be performed via an internal route, through the nose or mouth, or via an external route, percutaneously. One hundred and two ...rhinoplasties were carried out via the external route over a period of four years. For all 102 patients, the following criteria were taken into consideration: oedema and ecchymosis aroundthe eyes, the degree of closure of the roof, the symmetry and level of fractures, solidity of the bone pyramid and possible scarring at the access point of the osteotome. In the last 25 patients on whom surgery was performed,nasal endoscopy using optical fibres was carried out to evaluate theextent of damage to the mucosa caused by the two millimetre osteotome. Furthermore, in order to compare the two routes in vivo, for 5 of these patients, a surgeon from the Department, experienced in both techniques, carried out a lateral osteotomy externally for one side and internally for theother. The selection was random. Finally, lateral osteotomy was performed on five cadavers by an external route on one side and by an internal one on the other. Midface degloving was performed in order to expose the osteotomy sites. It can be said on the basis of our experience that external osteotomy is an easy and precise approach; as the fracture is of a greenstick type, the bone stumps are very stable; less bleeding means a reduced formation of edema and ecchymosis around the eyes; damage to the nasal mucosa is minimal and the cutaneous scars are virtually invisible a month after surgery.
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