INTERNAL AND EXTERNAL APPROACHES OF LATERAL OSTEOTOMY; A COMPARATIVE ANALYSIS

Background: Lateral osteotomy forms an irreplaceable part of Rhinoplasty for remodeling the external facet of bone,narrowing the nasal base and dorsum (after removal of dorsal hump) and achieve symmetry of an asymmetric frame work. Itis the penultimate step of a Rhinoplasty Surgery and is defined as the act of surgically fracturing the frontal process of maxilla,in order to close the open roof deformity following hump reduction and correct a flattened dorsum. There are two techniquesof Lateral Osteotomy described in the literature; External or Subcutaneous or Perforating approach and Internal or Submucousor Continuous approach. The superiority of one approach over the other is still up for debate and the choice of approachdepends, more often than not, on the operating surgeon’s comfort. Materials and Methods: In this composite study, the twoapproaches were analyzed based upon three parameters, namely, Incidence and Severity of Postoperative Periorbital Edema& Ecchymosis, Narrowing of Dorsal &Ventral Widths achieved and gain in Dorsal Height. Results: External Approach hasbeen found to be better in achieving the required dorsal height and avoiding severe postoperative periorbital edema andecchymosis. Unlike the Internal Approach, the External Approach promotes greenstick fracture. This ensures betterpostoperative healing and higher degree of stabilization of the nasal pyramid. Conclusion: External approach was found tohave better cosmetic results with lesser degree of postoperative peri-orbital edema and ecchymosis.