title: Lateral nasal osteotomy: a comparative study between the use of osteotome and a diamond surgical burr - a cadaver study.
abstract: BACKGROUND
  The ultimate goal of rhinoplasty is to achieve a controllable, reliable and an aesthetically pleasing result. Various approaches and instruments have been introduced for the correction of the bony walls of the nose to improve predictability of the procedure and to minimize the associated trauma. We conducted a cadaveric study comparing the results of osteotomy of the nasal wall using a diamond surgical burr with those using a 2-mm osteotome.
  
  
  METHODS
  Bilateral osteotomy of the nasal wall was performed on 10 cadavers. The 20 lateral nasal osteotomies were carried out on 7 females and 3 males of an age range between 61-91 years. A 2-mm osteotome was used percutaneously to perforate the lateral nasal wall of the right side. On the left side a 2-mm diamond surgical burr was introduced via an intraoral approach to thin out the lateral nasal wall. The in-fracture of the nasal bone was accomplished by controlled finger pressure. The nasal mucosa was inspected endoscopically and also dissected to identify any perforations or lacerations. The pattern of nasal fracture and the presence of any fragmentation of the bony segments were assessed clinically.
  
  
  RESULTS
  The in-fracturing of the nasal bone was accomplished by gentle pressure on the left side, but required more force on the contra lateral side. On the left side the in-fractured lateral nasal wall remained as one piece and no irregularities were seen. On the right side 3-5 bony fragments of irregular sizes and shapes were detected. There were 3-4 tears of the nasal mucosa, where the osteotome was applied. However, no mucosal tears were detected at the side, where the surgical burr was used.
  
  
  CONCLUSIONS
  Osteotomy of the lateral nasal wall with a diamond burr via intraoral approach is more precise and associated with fewer complications in comparison with the use of the osteotome.
authors.affiliation: Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital RWTH-Aachen, Pauwelsstraße 30, 52074 Aachen, Germany. aghassemi@ukaachen.de.
authors.forename: Alireza
authors.initials: A
authors.lastname: Ghassemi
authors.forename: Ashraf
authors.initials: A
authors.lastname: Ayoub
authors.forename: Ali
authors.initials: A
authors.lastname: Modabber
authors.forename: Behnam
authors.initials: B
authors.lastname: Bohluli
authors.forename: Andreas
authors.initials: A
authors.lastname: Prescher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D004867:Equipment Design; D005260:Female; D018460:Fractures, Comminuted / Q000517:prevention & control; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009295:Nasal Bone / Q000293:injuries / Q000601:surgery*; D009297:Nasal Mucosa / Q000293:injuries; D010027:Osteotomy / Q000295:instrumentation* / Q000379:methods; D012225:Rhinoplasty / Q000295:instrumentation*