Lateral rhinotomy through nasal aesthetic subunits. Improved cosmetic outcome

The traditional lateral rhinotomy incision described originally by Moure in 1902 has proved a versatile approach to the mid-facial skeleton. It is not, however, without its complications, particularly poor cosmesis due to depression of the nasofacial groove. In one series 10 per cent of patients developed wound complications. We present our modification of the lateral rhinotomy incision, that takes account of the nasal aesthetic subunits by placing the incision between the dorsal and side wall nasal subunits with extension inferiorly along the alar groove. From November 1994 to February 2001, a retrospective review of case notes showed that 20 patients underwent modified lateral rhinotomy incision for a variety of pathology. Ten cases were for transitional papilloma, nine for malignant disease and one for chronic osteitis of the maxilla and ethmoids post-trauma. Follow up ranged from two weeks to five years. In five cases we were able to preserve the bony piriform aperture without compromising the excision or exposure. We believe that preservation of the bony piriform aperture will further enhance the overall cosmesis and nasal function. No complaints related to the incision were recorded. Our experience with the modified lateral rhinotomy incision has been very satisfactory. It provides good exposure, a low complication rate and excellent cosmetic outcome without undue technical difficulty. It is our preferred incision for all surgery on the mid-facial skeleton and anterior skull base.