Which type of osteotomy for edema and ecchymosis: external or internal?

Osteotomy is one of the major parts of a rhinoplasty operation. Edema and ecchymosis most commonly appear as a result of this surgical manipulation. Different authors use different techniques to perform osteotomy. The external perforating approach and the internal continuous technique are the 2 main ways of doing osteotomy in rhinoplasty. In our study, we tried to compare the effects of these 2 techniques regarding edema and ecchymosis.

Two groups that consisted of 20 patients were studied. In group A, osteotomy was performed through an external route in a perforating fashion. In group B, the osteotomy was performed through an internal route and in a continuous fashion. The patients in each group were scored according to a visual scoring system that describes the site and extension of ecchymosis and degree of edema on the second and seventh days after the surgery. The scoring was made by 2 examiners blinded to the type of surgery.

Edema scores were almost the same between the 2 groups on the second and seventh days after the surgery. Ecchymosis scores were the same between the groups on the seventh day. However, the score for ecchymosis on the second day is significantly less in the internal continuous technique (P < 0.05) when it is compared with the external technique.

External and internal techniques of osteotomy almost give the same results regarding edema and ecchymosis, but the internal continuous technique shows a tendency to produce less ecchymosis on the second postoperative day.