The osteotomy in rhinoplasty

The purpose is to assist the surgeon in the selection of modifications for nasal osteotomies. Details of the technique include: 1. Incision for osteotomy made perpendicular to the pyriform rim and modified incisions, intraoral or through the Weir incision. 2. Rasping of the lateral nasal vault prior to any osteotomies. 3. Removal of a modified beveled wedge of bone prior to the medial osteotomy, unroofing the bony dorsum to a higher level. 4. The medial osteotomy done prior to either the lateral or the intermediate osteotomy. The intermediate osteotomy is performed prior to the lateral. 5. "Complete" and "fading" medial osteotomies are utilized as indicated. 6. The lateral osteotomy may be relatively straight and low depending then on a transverse fracture or may be high and curved meeting the fading medial osteotomy. 7. A sub-periosteal tunnel with the osteotome guard external to the bone is preferred to a submucosal tunnel.