Anatomical Relationship of lateral low-to-low nasal osteotomy and inferior nasal turbinate. Is Webster’s triangle still important?

Background Lateral low-to-low osteotomies in rhinoplasty raise safety concerns regarding Webster's triangle and airway patency. This study aimed to measure the distance between the osteotomy line and the anterior inferior nasal turbinate, and evaluate its relationship with other nasal characteristics. Methods We retrospectively analyzed CT scans from 81 East Asian patients (January-December 2020). This study used a virtual simulation to measure the distance between a projected lateral low-to-low osteotomy line and the anterior inferior nasal turbinate on CT scans, along with nasal bone length/thickness, pyriform aperture width, and rhinion–nasomaxillary suture distance. Linear regression and Spearman correlation assessed parameter associations. Results The 81 patients (mean age 46.7 years) showed an average distance of 7.1 ± 3.2 mm (right) and 6.5 ± 3.0 mm (left) between the osteotomy line and the inferior nasal turbinate. A significant negative correlation (r=−0.35, p<0.001) was found between rhinion–nasomaxillary suture distance and this osteotomy-turbinate distance. No correlation was seen with nasal bone length or pyriform aperture width. Measurements demonstrated good intra-rater reliability (ICC = 0.98). Conclusion The lateral low-to-low osteotomy line does not intersect the anterior nasal turbinate, indicating it can be safely performed without concern for Webster's triangle. However, caution is advised for patients with higher nasal dorsum projection (shorter rhinion–nasomaxillary suture distance). This study offers valuable insights into East Asian nasal characteristics for rhinoplasty. Keywords: Rhinoplasty, nasal osteotomy, Webster’s triangle, East Asian nasal anatomy, CT analysis, nasal turbinate, lateral osteotomy.