Internal Lateral and Medial Osteotomy

The Problem

The nasal bony pyramid is a complex anatomical structure. Lateral and medial osteotomies are planned and performed to contour and shape the bony vault. This step has a critical role in the function and aesthetic of the nose.

The Background

Osteotomy is a determinant part of the rhinoplasty. Historically, lateral osteotomy has been aimed to narrow a wide bony pyramid and create a smaller nose. The current tendency to have a normal looking nose with the preservation of, and even improved, nasal function has changed the indications of osteotomy. Lateral and medial osteotomies are strong modalities in the hands of an aesthetic surgeon to correct deformities and shape the bony pyramid, which may include narrowing the nose, widening the bony pyramid, and shaping the bony vault.

In general, osteotomy may be done by internal continuous technique, external dotted technique, or using piezosurgery instruments. Current literature shows that all these techniques with proper skills and expertise will end in optimal results. It is recommended to master one technique for routine rhinoplasties and be familiar with other techniques for special situations. For example, if improper fracture happens in an internal osteotomy, an external dotted osteotomy would be the best choice to revise the osteotomy plane; when external osteotomy is planned and performed but effective medialization does not happen, it is practical to switch to internal continuous osteotomy.

The Indications

• To narrow a wide bony pyramid

• To close an open roof after hump resection

• To widen a narrow bony pyramid

• To correct an asymmetric bony vault

The Case

The patient is a 29-year-old healthy male. His chief complaint was a big nose and projected hump. He desired a normal-looking nose that kept his breathing normal. An open approach rhinoplasty, incremental hump reduction, auto spreader f  lap, and lateral osteotomy with internal continuous osteotomy were planned and performed.