The Nasal Locator: An Innovative Instrument to Define the Exact Point of Osteotomy in Preservation or Structural Rhinoplasty

Overview

Most dorsal preservation techniques involve removing a strip of septum beneath the bridge, and the surgeon must know exactly where the cut has reached. Two risks follow: extending the cut too far, which can spread a fracture into the thin bone at the skull base and cause a leak of the fluid around the brain, and cutting too low to join the planned bone cut at the nasal root.

Sections of note

• Article type: instrument description. No patient numbers, outcomes or complication rates are reported.
• The device, called the Nasal Locator, has two tips. The lower tip is placed at the internal point to be determined, and the upper tip sits a fixed distance from it in all three dimensions, showing the external location.
• Stated uses: locating a subdorsal cut in cartilage or bone, and locating transverse or medial bone cut lines.
• The author states a literature and market search found no similar device.
• In use for almost 2 years, described as easy to use, needed for under 30 seconds, risk free and reusable.

What it means for a patient

• The cut beneath the bridge is made where the surgeon cannot see it directly, so knowing its exact position is a safety matter.
• The serious risk named is a fracture reaching the thin bone at the base of the skull, which can allow fluid around the brain to leak into the nose.
• The abstract carries no findings. Usefulness is stated from the author's own experience with no patient data or comparison.

Why this paper matters

Cerebrospinal fluid leak is rare but among the most serious complications of nasal bone surgery, and it comes from a cut extending further than intended. An instrument that locates the cut externally addresses that directly. Whether it reduces complications or improves accuracy has not been measured.

Terms

• Osteotomy: a planned cut or controlled fracture of bone.
• Subdorsal septal excision: removing a strip of septum from beneath the bridge so it can settle lower.
• Cribriform plate: the thin perforated bone separating the nose from the brain cavity.
• Cerebrospinal fluid leak: escape of the fluid surrounding the brain, usually through the nose.
• Transverse osteotomy: a cut across the top of the nasal bones.
• Radix: the root of the nose, the area between the eyes.