SELF: A Novel Algorithm for Deciding the Position of Lateral Osteotomies in Rhinoplasty Patients with Minimal External Deviation

Overview

Techniques for cutting the nasal bones date back decades, but little has been written about deciding the position of those cuts on each side. The author states the decision is usually made by looking at the face from the front and by feel, which is difficult in slightly crooked noses. The SELF algorithm uses four related parameters instead.

Sections of note

• Case series of 521 patients; the journal assigns level of evidence IV.
• Four hundred and ninety three patients were female and 28 male, aged 18 to 59 years.
• The four parameters are septal position at the nasal floor, external alar length, lateral pyramidal length and the side on which the frontal deviation starts.
• After evaluating those, either a double lateral or a high lateral osteotomy was performed on the side judged to have the longer bony wall.
• Four hundred and one double lateral and 85 high lateral osteotomies were performed.
• No serious functional or aesthetic complications related to the osteotomies were encountered.
• The author states the nasal tissues develop in relation to one another, which links these four parameters.

What it means for a patient

• The bone cuts that narrow or straighten the nose can be placed differently on each side, and the choice affects the result in a slightly crooked nose.
• The algorithm gives a repeatable basis for that choice rather than relying on inspection and feel.
• The stated outcome is the absence of serious complications, with no measurement of whether the noses ended up straighter.
• This is a single surgeon series with no comparison group.

Why this paper matters

Osteotomy placement is decided quickly during surgery and rarely documented, yet asymmetric placement is one route to a persistently crooked result. This paper proposes measurable criteria for it. Whether the algorithm produces straighter noses than judgment alone has not been tested.

Terms

• Lateral osteotomy: a bone cut along the side of the nose used to narrow or straighten it.
• Double lateral osteotomy: two cuts on the same side at different levels.
• High lateral osteotomy: a cut placed higher on the side wall.
• Bony pyramid: the bony upper part of the nasal framework.
• Alar length: the length of the nostril wing.
• Nasal floor: the base of the nasal cavity, where the septum meets the palate.