Lateral nasal osteotomies: Implications of bony thickness on fracture patterns - Discussion

Precise lateral nasal osteotomies combined with digital greenstick infracture can be a key feature in determining the success of a rhinoplasty procedure. This procedure may be difficult to perform consistently because the surgeon relies on tactile cues transmitted through intact soft tissue. In 17 cadavers with known demographics, bone fracture patterns after lateral osteotomy and digital greenstick infracture were studied and compared with measured lateral bone pyramid thicknesses. One side of each nose served to measure lateral wall thicknesses by drilling holes in a grid pattern and taking depth gauge measurements. Contralaterally, lateral osteotomy with digital greenstick infractures were performed. Consistent patterns of bone thickness were found. Bone was thinner near the pyriform aperture with a high fragmentation rate after osteotomy. Cephalocaudal thinning of the lateral bony pyramid near the medial canthus corresponded to the zone of greenstick fracture in 14 of 14 noses. Two major fracture pattern groups were noted. When lateral osteotomy was taken to the level of the medial canthus vertically, the greenstick fracture was consistent and predictable based on the transition in bone thickness from the radix area down across the lateral bony vault in untraumatized white cadavers.