eMedicine Specialties > Plastic Surgery > Nose

Rhinoplasty, Osteotomies

Author: John A Grossman, MD, Emeritus Chairman, Instructor, Departments of Otolaryngology and Plastic Surgery, University of Colorado Rose Medical Center
Coauthor(s): Linda Li, MD, Consulting Staff, Department of Plastic Surgery, Hospital of the Good Samaritan
Contributor Information and Disclosures

Updated: Oct 7, 2008

Introduction

The term osteotomy, derived from Greek, is defined in the medical dictionary as a surgical operation in which a bone is divided or a piece of bone is excised (as to correct a deformity). This article concerns the surgical technique of cutting bone in the performance of rhinoplasty (nasal surgery).

Problem

Most, although not all, rhinoplasties require the use of a form of osteotomy, because most standard rhinoplasties require the movement or alteration of the osseocartilaginous vault that composes much of the nose. For information on various rhinoplasty techniques, see the following eMedicine Plastic Surgery articles:

Frequency

American Society of Plastic Surgeons (ASPS) statistics for 2007 reported that more than 284,000 rhinoplasties (both cosmetic and reconstructive) were performed by its member plastic surgeons (this does not include procedures performed by otolaryngologists [ENTs], oral-maxillofacial surgeons, and others).1 For each of these surgeries, possibly 2-4 osteotomies were performed. Thus, this represents a conservative estimate of the frequency of rhinoplastic osteotomies.

Indications

In general, indications for osteotomies in rhinoplasty are anatomic findings of a high nasal dorsum that requires "hump" removal, an "open roof" after the hump has been removed, and a wide nasal base. Correcting these conditions requires osteotomies. Understanding these factors requires a familiarity both with the basic anatomy of the nose and surrounding facial and cranial structures and with the goals of aesthetic (cosmetic) and functional rhinoplasty.

Relevant Anatomy

Simplistically, the nose is a structure consisting of a bone and cartilage framework over which is draped a skin envelope. The size, shape, quality and/or thickness, texture, and position of the various parts help determine the appearance and function of the nose. The bony portion is referred to as "the bony vault." According to Oneal, Izenberg, and Schlesinger, "[It] … consists of the paired nasal bones and the frontal ascending processes of the maxilla. The vault is generally pyramidal in shape… The most narrow part of the bony pyramid is at the intercanthal line… Laterally the nasal bones articulate with the ascending or frontal process of the maxilla…"2 Surgeons who perform rhinoplasties need to have a thorough understanding of nasal anatomy.3

Contraindications

Contraindications for osteotomies lay within the contraindications for rhinoplasty. If the surgeon feels the patient is an appropriate candidate for rhinoplasty, osteotomy can be performed.

Aesthetic contraindications may exist wherein the nasal vault does not require narrowing and, even after hump removal, the lateral nasal bony plates lie in close enough approximation that osteotomy is unnecessary. Such decisions are within the purview of the individual rhinoplastic surgeon.

More on Rhinoplasty, Osteotomies

Overview: Rhinoplasty, Osteotomies
Workup: Rhinoplasty, Osteotomies
Treatment: Rhinoplasty, Osteotomies
Follow-up: Rhinoplasty, Osteotomies
Multimedia: Rhinoplasty, Osteotomies
References
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References

  1. American Society of Plastic Surgeons. 2000/2006/2007 National Plastic Surgery Statistics. American Society of Plastic Surgeons Web site. Available at http://www.plasticsurgery.org/media/statistics/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=29287. Accessed October 7, 2008.

  2. Oneal RM, Izenberg PH, Schlesinger J. Surgical anatomy of the nose. In: Daniel RK, ed. Rhinoplasty. 1993:27.

  3. Goodman WS, Gilbert RW. The anatomy of external rhinoplasty. Otolaryngol Clin North Am. Nov 1987;20(4):641-52. [Medline].

  4. Busca GP, Amasio ME, Sartoris A. [Complications of rhinoplasty]. Acta Otorhinolaryngol Ital. 1990;10 Suppl 31:1-37. [Medline].

  5. Cabouli JL, Guerrissi JO, Mileto A, Cerisola JA. Local infection following aesthetic rhinoplasty. Ann Plast Surg. Oct 1986;17(4):306-9. [Medline].

  6. Conrad K, Gillman G. Refining osteotomy techniques in rhinoplasty. J Otolaryngol. Feb 1998;27(1):1-9. [Medline].

  7. Giampapa VC, DiBernardo BE. Nasal osteotomy--utilizing dual plane reciprocating nasal saw blades: a 6-year follow-up. Ann Plast Surg. Jun 1993;30(6):500-2. [Medline].

  8. Goldfarb M, Gallups JM, Gerwin JM. Perforating osteotomies in rhinoplasty. Arch Otolaryngol Head Neck Surg. Jun 1993;119(6):624-7. [Medline].

  9. Harnick DB. A new and exact way to make an osteotomy at the nasofrontal bone junction [letter]. Plast Reconstr Surg. Nov 1993;92(6):1201-2. [Medline].

  10. Hunts JH, Patrinely JR, Stal S. Orbital hemorrhage during rhinoplasty. Ann Plast Surg. Dec 1996;37(6):618-23. [Medline].

  11. Isfendiyar MA. Intraoral versus intranasal approach to lateral osteotomy [letter; comment]. Plast Reconstr Surg. Oct 1993;92(5):984-5. [Medline].

  12. Kuran I, Ozcan H, Usta A, Bas L. Comparison of four different types of osteotomes for lateral osteotomy: a cadaver study. Aesthetic Plast Surg. Jul-Aug 1996;20(4):323-6. [Medline].

  13. Pontell J, Slavit DH, Kern EB. The role of outfracture in correcting post-rhinoplasty nasal obstruction. Ear Nose Throat J. Feb 1998;77(2):106-8, 111-2. [Medline].

  14. Rohrich RJ, Minoli JJ, Adams WP, Hollier LH. The lateral nasal osteotomy in rhinoplasty: an anatomic endoscopic comparison of the external versus the internal approach. Plast Reconstr Surg. Apr 1997;99(5):1309-12; discussion 1313. [Medline].

  15. Sullivan MJ, Krause CJ. Surgery of the bony and cartilaginous dorsum. Otolaryngol Clin North Am. Nov 1987;20(4):825-35. [Medline].

  16. Thomas JR, Griner N. The relationship of lateral osteotomies in rhinoplasty to the lacrimal drainage system. Otolaryngol Head Neck Surg. Mar 1986;94(3):362-7. [Medline].

  17. Thomas JR, Griner NR, Remmler DJ. Steps for a safer method of osteotomies in rhinoplasty. Laryngoscope. Jun 1987;97(6):746-7. [Medline].

  18. Trenite GJ. Trauma reduction in rhinoplastic surgery. Rhinology. Jun 1991;29(2):111-6. [Medline].

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Further Reading

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Keywords

rhinoplasty, osteotomies, osteotomy, fractures, infracture, outfracture, breaks, bony cuts, bone excision, cutting bone, nasal surgery, nose surgery, nasal bone, nasal fracture, nose job, nasal break

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Contributor Information and Disclosures

Author

John A Grossman, MD, Emeritus Chairman, Instructor, Departments of Otolaryngology and Plastic Surgery, University of Colorado Rose Medical Center
John A Grossman, MD is a member of the following medical societies: American Burn Association, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Laser Medicine and Surgery, American Society of Plastic Surgeons, Colorado Medical Society, Lipoplasty Society of North America, and Pan-Pacific Surgical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Linda Li, MD, Consulting Staff, Department of Plastic Surgery, Hospital of the Good Samaritan
Linda Li, MD is a member of the following medical societies: American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Frederick J Menick, MD, Clinical Associate Professor, Department of Surgery, Division of Plastic Surgery, University of Arizona College of Medicine; Private Practice in Tucson, Arizona
Frederick J Menick, MD is a member of the following medical societies: American Association of Plastic Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Plastic and Reconstructive Surgery, American Society of Plastic Surgeons, and Canadian Society of Plastic Surgeons
Disclosure: none None None

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

George Peck, Jr, MD, Consulting Staff, Department of Plastic Surgery, St Barnabas Hospital of New Jersey
George Peck, Jr, MD is a member of the following medical societies: American Society for Aesthetic Plastic Surgery
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Al Aly, MD, FACS, Consulting Surgeon, Iowa City Plastic Surgery
Disclosure: Ethicon  Consulting fee Consulting; QMP Royalty Book royalty; Insorb Stapler Consulting fee Consulting; Insorb Stapler Ownership interest None; Medicis Intellectual property rights None

 
 
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