Preservation Rhinoplasty Performed Simultaneously with Bimaxillary Orthognathic Surgery: Last Evolution in Orthofacial Surgery

Overview

Jaw repositioning surgery changes the shape and support of the nose, so combining it with rhinoplasty in one operation is attractive. The authors state very few studies have examined doing preservation rhinoplasty simultaneously. They retrospectively reviewed all patients with malocclusion who had both operations together at a single centre in Parma between January 2018 and December 2022.

Sections of note

• Design: retrospective single centre study. Level of evidence IV.
• 118 patients after exclusions: 41 men and 77 women, mean age 22 years, range 17 to 38.
• Preservation subtypes were classified: type 1 full let down, type 2 bone scoring plus full let down, type 3 bone scoring plus basal osteotomies plus cartilage let down, type 4 bone scoring plus cartilage let down, type 5 bone scoring plus upper cartilage rim resection.
• Distribution: type 1 in 29, type 2 in 34, type 3 in 27, type 4 in 16, type 5 in 12.
• Mean duration of the complete combined procedure: 207 minutes, range 170 to 220.
• 15 complication events occurred, 12.7 percent.
• Stated conclusion: simultaneous jaw surgery and preservation rhinoplasty is a viable option.

What it means for a patient

• Doing both at once means a single anesthetic and a single recovery rather than two operations months apart.
• The combined procedure took around three and a half hours, which is not dramatically longer than either operation alone.
• Complications occurred in roughly one in eight patients, though the abstract does not say what they were or which operation caused them.
• Limits: retrospective, single centre, no comparison against staged operations, and no aesthetic or breathing outcomes reported.

Why this paper matters

Jaw surgery alters the nasal base directly, so operating on the nose afterward means working on anatomy that has just changed. Combining them addresses that sequencing problem. Whether results match staged surgery, and what the 12.7 percent of complications consisted of, is unaddressed.

Terms

• Orthognathic surgery: surgery to reposition the jaws.
• Bimaxillary: involving both the upper and lower jaw.
• Malocclusion: a mismatch in how the upper and lower teeth meet.
• Preservation rhinoplasty: reshaping that keeps native nasal structures intact.
• Let-down: removing a wedge of bone from the side walls so the bridge settles lower.
• Bone scoring: making shallow cuts in bone to allow it to bend or reshape.