This is also called nasal bone reduction, and it corrects the basal nasal bone deviation prior to the emplacement of rhinoplasty prosthesis. Nasal osteotomy is aimed at narrowing the nasal bones to sculpt a delicate nasal bridge and then correcting the deviated nasal bones to avoid nasal bridge shift after the emplacement of the prosthesis. Structurally, the nasal bones only account for the superior one-third segment of the overall nasal bridge and are made up of two thin flakes that are osseum and ridge shaped. It measures only 1.5 mm on an average but bears the development and projection of the overall nasal bridge and also guides the development of the inferior two-thirds of the nasal septum. Therefore, nasal bone deviation and nasal septal warping (deviation) often concurrently occur, so if necessary, the nasal septal deviation should also be corrected. Generally, normally developed nasal bones are fixated prior to the age of 18 years and present the following disorders:
- Excessively broad or flat nasal bone
This is a hereditary problem and is mostly observed in patients with a broad zygomatic bone, typical of an exceedingly wide middle segment of the nasal bone from the frontal view and an overall bridge looks like a Coca-Cola bottle or gourd. Concurrent nasal septal collapse or depression (saddle nose) is occasionally reported. This type of nose predominantly presents with normal functions and generally only necessitates appearance correction.
- Congenital nasal bone deviation
This results from an unequally developed bilateral face (asymmetrical face) and is frequently complicated by nasal septal warping, nasal obstruction, or even upper palate bone shift. This type of nose is characterized by obviously unilaterally oriented warping or deviation of the nasal bridge from the frontal view and misalignment of the central glabella and supratip (philtrum) as well as the bilateral ala nasi and nostrils with asymmetrical size and shape. Corrective procedures are relatively complex.
- Traumatic nasal deviation
This refers to nasal warping caused by external impacts; its severity varies along with the time of trauma. Generally, the younger the patient is, the more obvious are the effects. Such a nose shape typically demonstrates that the inferior nasal septum is normal but that the superior nasal bridge deviates at the affected site, thus giving an appearance of C-shaped warping. A traumatic nasal deformity is restored by a closed nasal reduction within 2 weeks; otherwise, it should be adjusted by subsequent nasal corrective osteotomy by making an open incision.
In spite of the fact that nasal osteotomy is independently performed for the restoration of nasal bone trauma, it is mostly performed in conjunction with open (Korean-style) rhinoplasty to achieve esthetic result. Generally, Dr. Chuang evaluates whether the nasal bones are properly located for every patient undergoing rhinoplasty before the operation, and if necessary, he would recommend simultaneous nasal bone correction to obviate the deviation or shifting of the emplaced prosthesis, thus resulting in satisfaction. Nasal bone surgery (lateral or corrective osteotomy) comprises the following parts:
- Nasal bone reduction (lateral osteotomy)
The exceedingly wide nasal bones are cut at both connecting ends with the maxilla and are medially compressed, which makes the nasal bridge appear both straight and slim. The incisions are inside the nostril and imperceptible, while the crevice at the compression site automatically proliferates the bones and becomes fixated, which regains preoperative strength after approximately 1 month.
- Nasal bone straightening (corrective osteotomy)
The surgical method is the same as nasal bone reduction. Despite flexible adjustments of bilateral osteotomy paths due to the degree of deviation, the ultimate objective is to restore and fixate the deviated two flakes of bones to the midline, thus ensuring the accuracy of the emplaced prosthesis. Sometimes, the nasal septal deviation should be simultaneously corrected (septoplasty).
Nasal bone correction does not extend the recovery of overall rhinoplasty but results in more bruises or swelling. Therefore, a customized thermoplastic plaster splint should be postoperatively worn for 1 week to stabilize the nasal bridge.