Osteoectomy Instead of Osteotomy for Closing the Open Roof

Goals/Purpose: Repositioning and reshaping of the nasal bones are an integral part of most rhinoplasty procedures. Osteotomies are performed in various ways ("low to low", "low to high", "L", "curve", median, paramedian, oblique, for maneuver "offense-ture", "outfracture") depending on the indication of each patients. All of the new and conventional surgical methods however have their own limitations.

We hereby present the Chisel Scraping osteoectomy technique for lateral and medial osteotomies for managing of the nasal bone deformities that can overcome the diverse shortcomings of the conventional methods.

Methods/Technique: The operative method was used in 160 nasal bones osteotomies in 80 patients. A wide skeletonization of the bony-cartilage framework was used to have a total visual and manual control. The maxillary-nasal bone units are progressively thinned through the use of a narrow neck 8 mm curved chisel. In this way the lateral 2-4 mm of the chisel progressively weaken the fracture line and create a uniform fracture. The median osteoectomy is also performed in the same way to prevent a rocker deformity.

Results/Complications: With the osteoectomy technique, no functional problems were reported and no revisions were performed 2 revision planned. Osteoectomy and osteotomy revision rates for inadequate bone mobilization are similar but osteoectomy technique does not create functional problems as the osteotomy technique. Bruising and swelling seem less than osteotomy cases even if cold or ice aren’t used.

Conclusion: The osteoectomy technique comes completely out of the present surgical philosophy patterns therefore needs time to be mastered. Although this technique needs more operating time to be carried out gives considerable advantages in comparison with the classical techniques with osteotomes and hammer because offers a greater respect of nasal respiratory function and a much better nasal base width control, resulting in a more predictability of results, less trauma and therefore lower risk of post-operative complications. In addition, wide skeletonization and dissection of the nasal skin enables a better skin redrape both in patients with thick skin and in those with a large skin sleeve.