The lateral nasal osteotomy in rhinoplasty: an anatomic endoscopic comparison of the external versus the internal approach

A precise and reproducible lateral osteotomy is a requirement for successful rhinoplasty. Two basic techniques have evolved: the external perforated method and the internal continuous method. The literature supporting the external perforated technique maintains that it contributes to a controlled, stable fracture and produces less nasal airway narrowing, hemorrhage, edema, and ecchymosis; however, the continuous internal method is used by many rhinoplasty surgeons. Our study was designed to compare the two techniques in the fresh cadaver nose using a blinded endoscopic evaluation of the nasal mucosa after the osteotomies were performed by one of these two techniques. Nineteen fresh cadaver heads had an external perforated lateral osteotomy performed on one side and an internal continuous lateral osteotomy performed on the alternate side by an investigator with experience in the use of both osteotomies. In a blinded fashion, four different investigators used nasal endoscopy to detect mucosal perforations and bony irregularities. Eleven percent of the perforated osteotomies resulted in mucosal tearing as opposed to 74 percent of the continuous osteotomies (p < 0.001). This anatomic study confirms our clinical experience that the external perforated osteotomy results in a more controlled fracture with less intranasal trauma and can minimize the associated morbidity (hemorrhage, edema, and ecchymosis) in the rhinoplasty patient.