Lateral Osteotomy with Sawing Technique in Open Rhinoplasty

PURPOSE: Lateral osteotomy is an essential step in the correction of nasal bony asymmetry. Direct visualization allows accurate repositioning of the nasal bones compared to blind techniques, which require precision and manual dexterity. We propose direct visualization procedures in open corrective rhinoplasty. METHODS: The technique was used on 16 patients. All patients underwent open rhinoplasty with a columellar incision. The marginal incisions were extended on either side to allow access to the piriform aperture. A double hook was used to caudally retract the lower lateral cartilages and the fibrous connections between the upper and lower lateral cartilages were released until the piriform aperture was visualized. Through the incision, lateral osteotomy was performed using a reciprocating saw at that time with direct visualization. Additional procedures including augmentation rhinoplasty, hump resection, septoplasty and tip plasty were performed simultaneously. RESULTS: This method provided excellent exposure to the lateral nasal bones and allowed the lateral osteotomy to be carried out precisely using the reciprocating saw. CONCLUSION: This extended open rhinoplasty method is suitable for most individuals, allowing a wide surgical field.

Excision of a Nasal Dermoid Sinus Cyst via Open Rhinoplasty Approach and Primary Reconstruction Using Tutoplast-Processed Fascia Lata

Nasal dermoid sinus cysts are the most common congenital midline nasal lesion, accounting for 1% to 3% of all dermoid cysts, and 4% to 12% of all head and neck dermoids. Selection of the appropriate reconstruction technique, after dermoid resection, is important for treatment. Here we describe the successful management of a case with a nasal dermoid sinus cyst using an open rhinoplasty approach, and primary reconstruction using Tutoplast-processed fascia lata and crushed septal cartilage.

A Correction Of Unilateral Cleft Lip Nose Deformity using Porous High-density Polyethylene Columellar Strut

Even though many surgical techniques have been reported to correct the unilateral cleft lip nose deformity, it is very difficult to achieve optimal results. The authors used the porous high-density polyethylene(Medpor(R)) sheet as a columellar strut for alar cartilage repositioning and the triangular transposition flap based on the superior columella for correction of excess skin of alar web. A silicone implant was used for nasal dorsal augmentation. Additional techniques including segmental resection of the excessive alar cartilage on the normal side, freeing of the septal cartilage from the vomer, the nasal osteotomies, a Z-plasty on the afftected plica vestibularis, alar advancement of denuded alar base flap or an interalar cinch, and subcutaneous reduction of the external lateral triangle were also used to repair individual differences of the nasal deformities. Twenty-four patients (11 females and 13 males; mean age, 24 years) were included in this study. From six to thirty-four months(mean fifteen months) postoperatively, the patients were evaluated by the ordinary scale method and the anthropometric analysis using preoperative and postoperative nasal cast models. The analysis of the result was conducted by Paired samples T test. All the patients showed uneventful healing except three cases of columellar strut protrusion. By the ordinary scale method, "good" aesthetic results were noted. By the postoperative anthropometric analysis, the alar length of the normal side, the columellar length and the tip projection of both normal and affected sides were significantly increased. The nostril floor width of the affected side and the nose width were significantly decreased. In conclusion, this technique is valuable in the correction of unilateral cleft lip nasal deformity. But in cases of severe deformity, residual septal deviation, those who have received the operation several times, the porous high-density polyethylene sheet must be used carefully because of the protrusion.