Authors
1
Al Karama Teaching Hospital, Baghdad, Iraq
2
Department of Otolaryngology /Ghazi Al-Hariri Hospital for Surgical Specialties -Medical City Complex.
,
Document Type : Research Paper
Abstract
BACKGROUND:
osteotomies are commonly used in rhinoplasty to improve irregularities in the brow- tip aesthetic line and correct open roof deformities (diastasis of the nasal bones) associated with bony dorsum reduction. They can be performed laterally, medially, or intermediately. Lateral osteotomy could be done through either internal (endonasal) or external (percutaneous) approaches depending on surgeon preference and experience.
OBJECTIVE:
Is to compare results between internal and external lateral osteotomy in primary open rhinoplasty in regard to post-operative ecchymosis and edema, mucosal tear, Bone alignment and irregularities, nasal patency and Scaring in the external approach.
PATIENTS AND METHODS:
60 patients underwent primary open rhinoplasty in otorhinolaryngology / head and neck surgery department in Al-Shaheed Ghazi Al-Hariri hospital for surgical specialties in medical city complex at Baghdad for period from first of October 2018 to first of October 2019. Twenty five patients underwent internal lateral osteotomy and 35 patients underwent external lateral osteotomy. Assessed preoperatively by detailed history, examination, photography and subjectively using NOSE and ROE scores. Then they were followed up regularly at 2nd and 7th day post-operative to evaluate edema and ecchymosis scoring according to the scoring system of Kara and Gokalan, mucosal tear also checked using endoscopy. Then seen at 1st, 3rd, 6th months to assess bone alignment and irregularities, nasal patency and scar (for external lateral osteotomy approach).
RESULTS:
Edema was more prominent among the internal group in 2nd and 7th days with p value of (0.0001, 0.0004) respectively. Ecchymosis also was more prominent in internal group at 2nd and 7th days with p value of (0.0001). All patients in internal group had mucosal tear at 2nd day with significant p value (0.0001). Bone alignment and irregularities were more obvious among internal group with p value of (0.0001). Nasal patency scale was better among external group with p value of (0.031). Scar was imperceptible and did not bather the patients in external group.
CONCLUSION:
External lateral osteotomy is a safe and precise method offered a more predictable pathway and less post-operative complications.
- Saleh H. and Rennie C , pre- operative assessment for rhinoplasty, scott-brown`s otorhinolaryngology head and neck surgery, volume three , eighth edition, 2019;81: 1133-41.
- Kim David W. and Mau Ted, Surgical Anatomy of the Nose: A Foundation for Rhinoplasty, Bailey’s Head and Neck surgery, 2014; 179: 2924-28.
- Guyuron B., Surgical Anatomy and Physiology of the Nose, Guyuron Rhinoplasty,2012,1,page 4-19
- Anari S. and Singh Natt R., nasal septum and nasal valve, scott-brown`s otorhinolaryngology head and neck surgery, volume one, eighth edition, 2019;103: 1141-42.
- Russell W.H. Kridel, Angela Sturm, The Nasal Septum, cummings otolaryngology head and neck surgery, volume one, seventh edition, 2020;29: 1780.
- Adamson PA, Chen T. The dangerous dozen: avoiding potential problem patients in cosmetic surgery. Facial Plastic Surgery Clinic North Am 2008;16:195–202, vii.
- Zaidel DW, Cohen JA. The face, beauty, and symmetry: perceiving asymmetry in beautiful faces. Int J Neurosci 2005;115: 1165–73.
- Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004;130:157-63.
-
- Capone Randolph B., Papel Ira D., The Nasal Dorsum: Management of the Upper Two-Thirds of the Nose, , Bailey’s Head and Neck surgery ,2014;181: 2959- 60.
- Taub peter J, Baker Stephen B, nasal osteotomies: width manipulation, rhinoplasty mcgraw hill plastic surgery atlas, 2012;27:110 -11.
- Anthony P. Sclafani, J. Regan Thomas, M. Eugene Tardy Jr, Rhinoplasty, cummings otolaryngology head and neck surgery, volume one, seventh edition, 2020; 31: 1958.
- Jeffreye Janis, Jamil Ahmad and Rodrich RJ. , Rhinoplasty, Grabb and smith’s plastic surgery, 2014;48: 526-28.
- Guyuron B., Variations in Nasal Osteotomy: Consequences and Technical Nuances, Guyuron Rhinoplasty, 2012; 5: 134-37.
- Hashemi M., Mokhtarinejad F., Omrani M., Comparison between external osteotomy versus internal lateral osteotomy in rhinoplasty, Journal of Research in Medical Sciences 2005;1:10-15.
- Gryskiewicz JM, Gryskiewicz KM. Nasal osteotomies: a clinical comparison of the perforating methods versus the continuous technique, Plast Reconstructive Surgery,2004: 1445-56.
- 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. Plastic Reconstruction Surgery, 1997; 99:1309–12.
- Giacomarra V, Russolo M, Arnez ZM, Tirelli G: External osteotomy in Rhinoplasty, The laryngoscope ,March 2001: 433-38.
- Sinha V, Gupta D, More Y, Prajapati B, Kedia B , Singh S , External versus Internal osteotomy in Rhinoplasty, Indian Journal of Otolaryngology and Head and Neck Surgery 2006 ;59: 9-12.
- Yucel OT. Which type of osteotomy for edema and ecchymosis external or internal. Annuals of Plastic Surgery 2005;55: 587-90.
- Gholami M. and Vaezi A., Comparison of the Effects of External and Internal Lateral Nasal Osteotomies on Ecchymosis, Periorbital Edema, and Step off Deformity after Rhinoplasty, World J Plastic Surgery, 2019; 8: 345–51.
- Motamed S., Saberi A., Niazi F., Molaei H., Complications of Internal Continuous and Perforating External Osteotomy in Primary Rhinoplasty, 2017;6:166-68.
- Kiliç C, Ümit Tuncel, Ela Cömert, Ziya Şencan, Effect of the Rhinoplasty Technique and Lateral Osteotomy on Periorbital Edema and Ecchymosis. J Craniofacial Surgery 2015;26:430-33.
- Hinton AE., Hung T., Daya, O’Connell M., Visibility of Puncture Sites After External Osteotomy in Rhinoplastic Surgery, Arch Facial Plastic Surgery, 2003; 5:408-411.
- Helal MZ , El-Tarabishi M, Magdy Sabry S, Yassin A, Rabie A, Lin SJ., Effects of rhinoplasty on the internal nasal valve: a comparison between internal continuous and external perforating osteotomy, Ann Plastic Surgery.,2010;64: 649-57.
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