External vs. internal osteotomy in rhinoplasty

Abstract

External osteotomy is an easy approach to carryout and makes fracture with high precision along preset lines. The bone stump is stable. The damage to the nasal mucosa is much less. There is reduced bleeding, reduced edema and reduced ecchymosis around eyes. The cutaneous scar at the entry site of osteotome is invisible.

External osteotomy in rhinoplasty: Piezosurgery vs osteotome

“…Both approaches are widely practiced, and the surgeon's choice is generally based on his own preference and experience. Many authors have compared the two approaches in order to highlight their benefits and limitations [4]. In our past experience, external osteotomy has proved to result in unnoticeable cutaneous scars one month after surgery, limited bleeding and edema and minimal periorbital ecchymosis with the preservation of the nasal mucosa [1].…”

Effect of the Rhinoplasty Technique and Lateral Osteotomy on Periorbital Edema and Ecchymosis

“…4,5 Therefore, the results of various studies have been conducted on subjects such as comparing internal and external lateral osteotomy, open and closed rhinoplasty techniques, the effects of steroid, decongestants, and local heparinoids. 1,[6][7][8] The present study aimed to compare the differences in the development of edema and ecchymosis in the early and late postoperative periods after different surgical approaches (open and endonasal techniques) and different lateral osteotomy types (internal/continuous and external/perforating), while maintaining the changeable parameters equivalent.…”

Visible Perforating Lateral Osteotomy: Internal Perforating Technique with Wide Periosteal Dissection

“…The lateral osteotomy is an essential procedure of cosmetic surgery, usually performed in order to narrow a wide nasal bone base, to resolve an open roof deformity after a humpectomy, or to refine the nasal bony pyramid. Surgeons can select from two basic methods to perform a lateral osteotomy: the external perforating method or the internal continuous method [ 1 2 3 4 5 6 ]. Advocates of the external perforating method state that it is associated with less mucosal and periosteal trauma, superior bone stump stability from periosteal support, and a more controlled fracture [ 1 2 6 ].…”

“…Surgeons can select from two basic methods to perform a lateral osteotomy: the external perforating method or the internal continuous method [ 1 2 3 4 5 6 ]. Advocates of the external perforating method state that it is associated with less mucosal and periosteal trauma, superior bone stump stability from periosteal support, and a more controlled fracture [ 1 2 6 ]. Alternatively, advocates of the internal continuous method prefer the superior mobility of the bony vault and consistent narrowing of the nasal pyramid [ 1 7 ].…”

“…These standard lateral osteotomy methods are responsible for significant periorbital swelling and ecchymosis from injuries to the periosteum and to the intranasal mucosa attached to the osteotomy sites, which can be exacerbated by limited visualization in the surgical field. Despite some debate over the solutions to these problems, it is generally agreed that the ideal osteotomy method would produce precise, predictable, and reproducible results with fewer complications [ 6 ]. Patient reports of edema, mucosal tearing, ecchymosis, unfavorable and incomplete fractures, and unsatisfactory aesthetic outcomes are common after a lateral osteotomy is performed; this is especially true for cases in which visualization of the surgical field was impaired [ 5 6 8 9 ].…”