title: Nasal osteotomies: a cadaveric study of fracture lines.
abstract: OBJECTIVE
  The different nasal osteotomy patterns used to perform rhinoplasty are poorly described in the literature, and there is a continuous debate between surgeons on the ideal sequence and technique to obtain desired results.
  
  
  OBJECTIVE
  (1) To evaluate the necessity of a paramedian osteotomy when performing a high-low-high (HLH) osteotomy, (2) to study the fracture pattern of a high-low-low (HLL) osteotomy when combined with a paramedian osteotomy in the presence and in the absence of a transverse osteotomy, and (3) to evaluate the mobility of the central segment (located between the paramedian osteotomies) after digital pressure and the ideal osteotomy to mobilize it if needed.
  
  
  METHODS
  This was a prospective cadaveric study performed in the dissection laboratory in our tertiary referral center.
  
  
  METHODS
  Twenty cadavers were divided in 2 groups of 10. Group A had a paramedian osteotomy combined with an HLH osteotomy on 1 side and an HLH osteotomy alone on the other side. Group B had a paramedian combined with a transverse osteotomy followed by HLL osteotomy on 1 side. On the other side, we performed a paramedian combined with an HLL osteotomy. Finally, we evaluated the mobility of the central segment in group B, first with digital manipulation and then with a transverse osteotomy.
  
  
  METHODS
  The 3 authors evaluated individually the different fracture patterns. A result was considered successful when (1) the fracture followed the desired pattern, (2) a continuous line was obtained, and (3) a complete mobilization of the nasal segment was visualized.
  
  
  RESULTS
  In group A, the side without a paramedian osteotomy had more unstable and greenstick fractures than the other side (P < .001). In group B, the side with a transverse osteotomy had more reliable and stable fractures than the other side (P < .05). Digital manipulation alone was not enough to mobilize the central segment in 8 of the 10 cadavers studied.
  
  
  CONCLUSIONS
  Following this study we make the following suggestions: (1) to perform a paramedian osteotomy when an HLH osteotomy is needed, (2) to perform a transverse osteotomy before an HLL osteotomy when combined with paramedian osteotomy, and (3) to manipulate the central segment with a transverse osteotomy in order to mobilize it in a safe and predictable manner.
  
  
  METHODS
  NA.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Québec, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Gabra
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Québec, Canada.
authors.forename: Akram
authors.initials: A
authors.lastname: Rahal
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Québec, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Ahmarani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D012225:Rhinoplasty / Q000379:methods*