A Comparison between External versus Internal Lateral Osteotomy in Rhinoplasty

M Hashemi, F Mokhtarinejad, M Omrani


Background: Lateral osteotomy is a major part of rhinoplasty for remodeling external facet of the nose and narrowing of
nasal base and dorsum after removal of the hump. There are two techniques for lateral osteotomy known as external and internal. Each of these provide advantages and impose limitations. The purpose of our study was to compare the severity of postoperative edema and ecchymosis between internal and external osteotomy techniques.
Methods: This study was designed as a clinical trial on 30 cases. With randomization, one side of the nasal bone was selected for internal approach, and the other side, for external approach. Then, on the 1st and 7th days after surgery, the patients were scored for the severity of edema and ecchymosis.
Results: On the first day after surgery, not only edema, but also ecchymosis was lower with the external osteotomy than with the internal approach (P = 0.037, P = 0.002, respectively). The severity of ecchymosis, on the 7th postoperative day, was lower with the external approach, and the difference was significant (P = 0.011). The severity of both edema and ecchymosis on the first postoperative day was evaluated higher in females, with statistically significant differences (P = 0.05 for edema and P = 0.003 for ecchymosis). The extension of ecchymosis on the 7th postoperative day was higher in women (P = 0.05). There were no significant differences between the two approaches in medialization of the involved bones and no apparent asymmetries either.
Conclusion: According to the results of this study, external osteotomy seems to be the approach of choice, provided that the surgeon has enough experience in doing it.
Keywords: Rhinoplasty, Internal osteotomy, External osteotomy, Ecchymosis, Edema

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