A Comparison between External versus Internal Lateral Osteotomy in Rhinoplasty

Background: Lateral osteotomy is a major part of rhinoplasty for remodeling external facet of the nose and narrowing ofnasal base and dorsum after removal of the hump. There are two techniques for lateral osteotomy known as external and internal.Each of these provide advantages and impose limitations. The purpose of our study was to compare the severity of postoperativeedema and ecchymosis between internal and external osteotomy techniques.Methods: This study was designed as a clinical trial on 30 cases. With randomization, one side of the nasal bone was selectedfor internal approach, and the other side, for external approach. Then, on the 1st and 7th days after surgery, the patients werescored for the severity of edema and ecchymosis.Results: On the first day after surgery, not only edema, but also ecchymosis was lower with the external osteotomy than withthe internal approach (P = 0.037, P = 0.002, respectively). The severity of ecchymosis, on the 7th postoperative day, was lowerwith the external approach, and the difference was significant (P = 0.011). The severity of both edema and ecchymosis on thefirst postoperative day was evaluated higher in females, with statistically significant differences (P = 0.05 for edema and P =0.003 for ecchymosis). The extension of ecchymosis on the 7th postoperative day was higher in women (P = 0.05). There wereno significant differences between the two approaches in medialization of the involved bones and no apparent asymmetrieseither.Conclusion: According to the results of this study, external osteotomy seems to be the approach of choice, provided that thesurgeon has enough experience in doing it