Author/Editor		Giacomarra, Vittorio; Russolo, Mario; Arnež, Zoran M; Tirelli, Giancarlo; Bianchi, M
Title		External osteotomy in rhinoplasty
Translated title		Zunanja osteotomija v rinoplastiki
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 39, št. Suppl 3
Publication year		2000
Volume		str. 245-9
Language		eng
Abstract		Lateral osteotomy is a fundamental step in rhinoplasty. It can be performed via an internal route, through the nose or mouth, or via an external route, percutaneously. One hundred and two rhinoplasties were carried out via the external route over a period of four years. For all 102 patients, the following criteria were taken into consideration: oedema and ecchymosis around the eyes, the degree of closure of the roof, the symmetry and level of fractures, solidity of the bone pyramid and possible scarring at the access point of the osteotome. In the last 25 patients on whom surgery was performed, nasal endoscopy using optical fibres was carried out to evaluate the extent of damage to the mucosa caused by the two millimetre osteotome. Furthermore, in order to compare the two routes in vivo, for 5 of these patients, a surgeon from the Department, experienced in both techniques, carried out a lateral osteotomy externally for one side and internally for the other. The selection was random. Finally, lateral osteotomy was performed on five cadavers by an external route on one side and by an internal one on the other. Midface degloving was performed in order to expose the osteotomy sites. It can be said on the basis of our experience that external osteotomy is an easy and precise approach; as the fracture is of a greenstick type, the bone stumps are very stable; less bleeding means a reduced formation of edema and ecchymosis around the eyes; damage to the nasal mucosa is minimal and the cutaneous scars are virtually invisible a month after surgery.
Summary		Lateralna osteotomija je eden od temeljnih posegov v rinoplastiki. Lahko se opravi z notranjim pristopom (t. j. skozi nos ali usta) ali z zunanjim pristopom (t. j. perkutano). V času štirih let smo opravili 102 rinoplastiki z zunanjim pristopom. Pri vseh 102 bolnikih smo upoštevali naslednja merila: edem in ekhimoze okoli oči, stopnjo zaprtja stropa nosne votline, simetrijo in raven preloma kosti, trdnostkostne piramide in morebitno brazgotinjenje na mestu dostopa osteotoma. Pri zadnjih 25 bolnikih, pri katerih je bil ta poseg opravljen, smo naredili tudi fiberoptično endoskopijo nosu, da bi lahko ovrednotili obseg poškodb sluznice, ki jih je povzročil dvomilimetrski osteotom. Da bi lahko primerjali oba dostopa in vivo, je pri 5 od teh bolnikov oddelčni kirurg z izkušnjami iz obeh tehnik opravil lateralno osteotomijo z zunanjim pristopom na eni strani in z notranjim pristopom na drugi. Izbira teh 5 bolnikov je bila naključna. Na koncu raziskave smo opravili lateralne osteotomije na petih kadavrih, z zunanjim na eni strani in z notranjim pristopom na drugi. Da bi odkrili osteotomijska mesta, smo jim odluščili kožo na osrednjem delu obraza. Na podlagi lastnih izkušenj lahko rečemo, da pomeni pri tem posegu zunanja osteotomija lahek in natančen pristop. Ker kosti lomimo po tipu "greenstick", so dobljeni kotni nastavki zelo stabilni. Manjša krvavitev pomeni tudi manj edema in ekhimoz okoli oči. Poškodbe nosne sluznice so minimalne, kožne brazgotine pa postanejo praktično nevidne že en mesec po posegu.
Descriptors		RHINOPLASTY OSTEOTOMY PATIENT SELECTION TREATMENT OUTCOME ESTHETICS HEMORRHAGE NASAL MUCOSA CICATRIX