Aesthetic and technical aspects of nasal osteotomies

Abstract

Osteotomies of the nose including the lateral nasal bones, dorsal hump, and anterior nasal spine, are reviewed.The author shares his indications and techniques for these procedures. Some of the salient points made include the following: (1) In general lateral osteotomies are overdone. When in doubt, they should not be done or deferred. By maintaining the upper third of the nose on the larger side, one keeps the tip portion of the nose small by comparison. Because the tip is the hardest part of the nose to make smaller, it is best to adjust the upper half of the nose to the limiting width of the lower half of the nose. (2) There seems to be a tendency to underdo the medial osteotomy, causing some noses to have narrow nasal bone bases but broad dorsal components. (3) There are a number of sculpturing considerations for osteotomies. Nasal bones should be thought of in four separate sections: the base, where it is often broad; the dorsal aspect of the nasal bones, where it may be broad; the cephalic portion; and the caudal portion. Consideration of reduction of the nasal bones should take into account which combination of the four portions of the nasal bones need to be reduced. (4) Lateral osteotomy from the buccal-sulcus approach is an outstanding method of controlling the width of the nasal bones. It eliminates one more incision from the nose. It allows any blood that accumulates to exit from the mouth rather than by the nose, and thereby minimizes nasal bleeding. (5) The open approach is not an indication for osteotomies, but it does allow one to see the extent of the medial osteotomy. In some cases it can help establish what is causing the nasal bones to not come together properly.