Surgery of the Bony and Cartilaginous Vault in Rhinoplasty

An osteotomy must be performed in almost all types of external nose correction. By mobilising the bony skeleton, the nose may be sculpted into the desired shape and position. The osteotomy is carried out as gently as possible in an effort to minimize postoperative swelling and soft tissue bleeding. Finger and sharp chisels are used. Nasal bones are accessed through a short intercartilaginous incision above the lateral nasal cartilage. The outer periosteum is pushed to the side, then an osteotome is placed about 2mm paramedially and, using rhythmic taps of a metal mallet, a medial osteotomy is performed. The position of the osteotome is checked by finger palpation on the nasal dorsum. The osteotome is worked through the bone up to the level of the frontal bone. Before removal, the resilience of the nasal bone is checked by turning the instrument laterally.