Clin Exp Otorhinolaryngol.  2023 Feb;16(1):59-66. 10.21053/ceo.2022.01095.

One-Unit Osteotomy to Correct Deviated Bony Dorsum

• Kim BK
• Heo Y
• Park SI
• Hong SD
• Jung YG
• Kim HY

• KMID: 2539769
• DOI: http://doi.org/10.21053/ceo.2022.01095

Abstract

Objectives
. A crooked nose is frequently caused by nasal bony vault deviation, and proper management of the bony vault is an integral part of rhinoplasty. Conventional osteotomy to correct a deviated nose favors simultaneous medial and lateral osteotomies, which allows the free independent movement of each nasal bone. However, patient satisfaction with deviated nose surgery is sometimes low. In the present study, we introduce a one-unit osteotomy procedure that combines bilateral and root osteotomies with unilateral triangular bony wedge resection to allow symmetry of both nasal bones.
Methods
. Twenty consecutive patients who presented with bony vault deviation and underwent one-unit osteotomy were enrolled in this retrospective single-center study. The Nasal Obstruction Symptom Evaluation (NOSE) questionnaire was used to evaluate each patient’s functional outcome. The angle of bony vault deviation before and after one-unit osteotomy was measured using a protractor and compared with the results of 14 patients who had undergone conventional osteotomy. The improvement in dorsal deviation was evaluated using facial photography preoperatively and 3 months postoperatively.
Results
. NOSE values improved from 8.4±6.4 to 4.1±4.2 (P =0.021). The angle of bony vault deviation improved from 6.9°±2.2° to 2.1°±1.2° (P <0.001) in one-unit osteotomy and from 7.3°±4.0° to 2.7°±1.2° (P =0.001) in conventional osteotomy. The preoperative deviation angle improved by 70.3% in one-unit osteotomy compared with 56.6% in conventional osteotomy, which was a significant difference (P =0.033). The mean grade of the postoperative esthetic outcomes for the remaining deviation was 1.6±0.5, which was similar to that in the conventional osteotomy group.
Conclusion
. One-unit osteotomy is a relatively simple procedure that balances the width of both lateral walls by removing excessive bony fragments from the wider bony wall and providing better structural integrity. This technique improves functional outcomes and has equivalent esthetic results to those of the traditional procedure.

Keyword

Osteotomy; Rhinoplasty; Nasal Bone; Nose

Figure

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  Fig. 1. Illustration of one-unit osteotomy and endonasal septoplasty. (A) A greenstick fracture is made in the dorsal area of the perpendicular plate of the ethmoid, and two vertical holes are created below the fracture line using a 2.5-mm drill. (B) The bony wedge of the frontal process of the maxilla on the wider side is excised, and conventional lateral osteotomy is performed on the contralateral side. (C) The entire bony vault is mobilized as one unit. (D) To allow remaining high dorsal septal deviation to be fixed to the midline, the modified mattress suture technique is performed.

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  Fig. 2. Surgical method of one-unit osteotomy for a deviated bony vault. (A) The width of both lateral bony walls is measured, and the amount of surplus bony wall resection on the wider side is estimated. (B) Intraoperative photographs of the width of the lateral bony wall measured with a surgical ruler. (C) Resection of excess bone on the wider side of the lateral bony wall. A drill inserted into the bony wedge of the frontal process of maxilla while confirming the location by palpation. (D) Endoscopic view of the resected lateral bony wall (asterisk) and saved internal mucosa.

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  Fig. 3. Preoperative and postoperative photographs and computed tomography (CT) of a deviated bony vault corrected with one-unit osteotomy. (A, B) Preoperative photograph. (C) Axial view of a preoperative CT scan. (D) Coronal view of a preoperative CT scan. (E, F) Postoperative photograph. (G) Axial view of a postoperative CT scan. The width of both lateral bony walls are changed symmetrically, and fracture lines (arrows) are observed. (H) Coronal view of a postoperative CT scan. A greenstick fracture (arrow) is usually made in the dorsal area of the perpendicular plate of ethmoid during septoplasty, which facilitates the correction of the bony septum and dorsum.

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  Fig. 4. Preoperative and postoperative photographs and computed tomography (CT) of a deviated bony vault corrected with one-unit osteotomy. (A, B) Preoperative photograph. (C) Axial view of a preoperative CT scan. (D) Three-dimensional view of a preoperative CT scan. (E, F) Postoperative photograph. (G) Axial view of a postoperative CT scan. The width of both lateral bony walls is changed symmetrically, and fracture lines (arrows) are observed. (H) Three-dimensional view of a postoperative CT scan. The entire nasal bony pyramid (asterisk) is mobilized in one-unit and repositioned to the midline.

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  Fig. 5. Measurement of bony vault deviation: the angle between the lines a-b and b-c. (a) The philtrum, (b) the nasion, and (c) the most prominent point of the bony vault deviation

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  Fig. 6. Changes in the bony vault deviation angle. (A) One-unit osteotomy group. The deviation angle improved from 6.9°±2.2° to 2.1°±1.2° (P<0.001). (B) Conventional osteotomy group. The deviation angle improved from 7.3°±4.0° to 2.7°±1.2° (P=0.001). There was no significant difference in the postoperative deviation angle between the two groups (P=0.158). However, the relative improvement compared to the preoperative angle (Δdeviation angle/preoperative angle×100) was 70.3% for one-unit osteotomy, which was better than that achieved using conventional osteotomy (56.6%, P=0.033).

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