A Predictable Approach for Osteotomy in Rhinoplasty: A New Concept of Open External Osteotomy

Hontanilla B, Cabello A, Olivas J.

PubMed 27482503 Publisher (DOI)Free full text (PMC)

What this paper says

The authors describe cutting the nasal bones under direct view instead of blindly, which they say gives more precise control and less bruising and swelling afterward; the abstract reports no patient numbers.

Overview

After a dorsal hump is lowered, the roof of the nose is left open and the bones must be cut and moved inward to close it. The authors state that surgeons disagree about the best way to make these cuts and that technique choice usually comes down to personal preference. This paper proposes performing both the medial and the lateral bone cuts where the surgeon can see them rather than by feel.

Sections of note

The paper is a technique description, not a study with a comparison group.
Both medial and lateral osteotomies are performed under direct vision.
The stated rationale is that blind cuts are less predictable and less precise.
Claimed advantages include preserving the nasal muscles, the angular blood vessels, and the periosteum.
Claimed downstream effects are less bruising and swelling, and lower risk of internal scar bands and tear sac injury.
The abstract gives no patient count, follow-up length, complication rate, or outcome measurement.

What it means for a patient

The idea is that seeing the bone cuts should make the result more repeatable across surgeons.
No numbers are reported, so the claimed reduction in bruising and swelling is not measured in this abstract.
There is no comparison group and no follow-up period stated.
The authors say the approach may suit both new and experienced surgeons.

Why this paper matters

Osteotomy remains one of the least standardized steps in rhinoplasty, and how it is done affects both nasal width and recovery appearance. This paper adds one more option to that debate. Whether direct vision actually reduces bruising or improves accuracy is not tested here.

Terms

Osteotomy: A controlled surgical cut through bone.
Open roof deformity: The flat gap left across the top of the nose after a hump is removed.
Periosteum: The thin living membrane wrapping bone.
Ecchymosis: Bruising under the skin.
Synechia: A scar band joining two surfaces inside the nose.

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

Abstract

Nasal osteotomies are a cornerstone step for closing an open roof deformity after dorsal hump surgery. Notwithstanding, the optimal method of nasal osteotomy remains controversial, as evidenced by the variety of approaches with no consensus between authors. Moreover, the election of the technique responds to surgeon's preference. We proposed a new way to perform both medial and lateral osteotomies under direct vision. Direct vision of nasal osteotomies provides more predictable control and precision than blind procedures, making this procedure more reliable and easier for both novel and experienced surgeons. Other advantages include conservation of nasal muscle, angular vasculature, and periosteum, which allow less postoperative ecchymosis and edema and less risk of synechia and lacrimal sac injury.

Abstract as indexed by PubMed; the article is open access (PubMed Central).