No osteotomy rhinoplasty: indications and surgical details

Arslan E.

What this paper says

In 34 patients whose only reason for bone cuts was to close the open roof after hump removal, the author skipped the osteotomies, folded the upper lateral cartilages inward as auto spreader flaps and braced the side walls with onlay grafts; one patient lacked side wall support.

Overview

Lateral osteotomies, the bone cuts along the sides of the nose, are done to close the flat "open roof" left after a hump is removed, to narrow the nose or to straighten asymmetric bones. When closing the roof is the only reason, the author argues the cuts can be avoided by using the preserved upper lateral cartilages as flaps and adding onlay grafts to the side walls.

Sections of note

34 patients; level of evidence V.
Indication: cases where the sole purpose of lateral osteotomy would be closing an open roof.
Component hump reduction preserves the full upper lateral cartilage on both sides, including the part under the nasal bone.
The flaps are sutured together in the midline with a modified technique; the lateral nasal walls are supported with onlay cartilage grafts.
Lack of lateral wall support was obvious in 1 patient.
The author calls for further studies with more patients and longer follow-up.
The abstract gives no follow-up length, satisfaction or breathing data.

What it means for a patient

Some patients can have a hump removed without breaking the nasal bones, which may mean less bruising, though the abstract does not measure that.
The approach applies only when the bones do not also need narrowing or straightening.
Small series with one visible failure and no stated follow-up; the author regards the concept as unproven.

Why this paper matters

Avoiding osteotomies is a recurring goal and later became central to dorsal preservation techniques. This paper defines a narrow indication for doing so within conventional hump reduction. Its evidence is preliminary.

Terms

Lateral osteotomy: the bone cut along the side of the nose used to narrow it or close an open roof.
Open roof deformity: a flat, wide upper bridge left when a hump is removed and the bones stay apart.
Auto spreader flap: the upper lateral cartilage folded inward to act as its own spreader graft.
Component hump reduction: removing a hump in stages, cartilage and bone separately, to keep the upper lateral cartilages intact.
Onlay graft: a cartilage piece laid on a surface to add support or fill a contour.
Upper lateral cartilages: the paired cartilages forming the sides of the middle third of the nose.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Lateral osteotomy is a particular step in rhinoplasty that aims to close an open roof deformity after hump reduction, narrow the lateral walls of the nose, and symmetrically align the nasal bony framework in cases with asymmetry. When the only reason for performing lateral osteotomy is to close an open roof, this can…”

Excerpt; the full abstract is on PubMed.