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Effect of the sequence of lateral osteotomy and hump removal on the aesthetic outcome
Alireza Ghassemi1, Andreas Prescher, Ralf-Dieter Hilgers
1Department of Oral, Maxillofacial Plastic, and Reconstructive Surgery, University Hospital RWTH-Aachen, Aachen, Germany. aghassemi@ukaachen.de
Background:
The authors hypothesized that by modifying the sequence of the rhinoplasty procedure they could avoid comminuted fractures resulting in suboptimal cosmetic results.
Methods:
Percutaneous perforated lateral nasal osteotomies were performed in 36 fresh human cadaver heads. In the first group of 19 cadaver heads with big nasal humps, the perforations of the lateral wall were done before and digital infracturing after hump removal in 10 cases (subgroup A1). In the remaining 9 noses with big humps, the perforations and digital infracturing were performed after hump removal (subgroup group A2). In a second group of 17 cadaver heads with small humps, perforations were performed before hump removal in 8 cases (subgroup B1), and in the remaining 9 cases, the lateral walls were perforated after hump removal (subgroup B2). The number of fractured nasal bones was counted. In addition, the size and shape of the nasal bone fragments were described in a blinded fashion.
Results:
Analysis of the number of fractured nasal bones yields higher rates for "osteotomies after" (8.44 vs. 5.83) and hump size "big" (8.37 vs. 5.76), with some influence of age and gender.
Conclusions:
The pattern of fractures after perforations of the lateral wall seems to be more regular if the perforations are done before the removal of bigger humps. In noses with small humps or no hump, no difference is seen regarding the sequence of the perforations in relation to hump removal.