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Anatomical Relationship of Lateral Low-to-Low Nasal Osteotomy and Inferior Nasal Turbinate. Is Webster's Triangle
Atchara Setthajindalert1, Padcha Tunlayadechanont2, Thiti Tantitham1
1Division of Plastic and Maxillofacial Surgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Background:
Lateral low-to-low osteotomies in rhinoplasty raise safety concerns regarding Webster's triangle and airway patency. This study aimed to measure the distance between the osteotomy line and the anterior inferior nasal turbinate and evaluate its relationship with other nasal characteristics.
Methods:
We retrospectively analyzed CT scans from 81 East Asian patients (January-December 2020). This study used a virtual simulation to measure the distance between a projected lateral low-to-low osteotomy line and the anterior inferior nasal turbinate on CT scans, along with nasal bone length/thickness, pyriform aperture width, and rhinion-nasomaxillary suture distance. Linear regression and Spearman correlation assessed parameter associations.
Results:
The 81 patients (mean age 46.7 years) showed an average distance of 7.1 ± 3.2 mm (right) and 6.5 ± 3.0 mm (left) between the osteotomy line and the inferior nasal turbinate. A significant negative correlation ( r = -0.35, p < 0.001) was found between rhinion-nasomaxillary suture distance and this osteotomy-turbinate distance. No correlation was seen with nasal bone length or pyriform aperture width. Measurements demonstrated good intrarater reliability (intraclass correlation coefficient [ICC] = 0.98).
Conclusions:
The lateral low-to-low osteotomy line does not intersect the anterior nasal turbinate, indicating it can be safely performed without concern for Webster's triangle. However, caution is advised for patients with higher nasal dorsum projection (shorter rhinion-nasomaxillary suture distance). This study offers valuable insights into East Asian nasal characteristics for rhinoplasty.
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