Understanding Why Lateral Osteotomy During Rhinoplasty Can Be Performed Safely

Area of Science:

• Plastic Surgery
• Anatomy
• Surgical Techniques

Background:

• Lateral osteotomy is crucial in rhinoplasty for nasal bridge modification.
• Preserving a maxillary bone strut is key to preventing midvault collapse.
• The "high-low-high" technique aims to maintain this strut.

Purpose of the Study:

• To assess the safety of initiating lateral osteotomies in the "high" position.
• To determine if this placement risks aberrant fractures along the nasomaxillary suture.
• To evaluate the preservation of the triangular maxillary strut.

Main Methods:

• High-definition computed tomographic (CT) scans of 20 patient skulls were used.
• 3-dimensional reconstructions allowed precise anatomical measurements.
• Distances from the rhinion to the nasomaxillary suture and maxillary groove were measured.

Main Results:

• The nasomaxillary suture line was consistently found halfway down the bony nasal pyramid.
• This suture line was not close to the maxillary groove.
• A significant triangular strut of maxillary bone can be preserved.

Conclusions:

• Starting lateral osteotomies high is safe and does not risk aberrant fractures.
• A generous triangular strut can be preserved without compromising the nasomaxillary suture.
• Controlled lateral osteotomies enhance aesthetic outcomes while maintaining midvault stability.