Abstract
Background
Although the different techniques and instruments described for lateral osteotomies date back decades, the literature on deciding the position of lateral osteotomies between the sides is limited. In general, the position of lateral osteotomies is decided by frontal view and palpation, but this is not always easy, especially in minimally deviated noses.
Methods
The SELF algorithm, which includes 4 developmentally related parameters, was used to decide the position and number of lateral osteotomies. Parameters of the SELF algorithm are septal position in nasal floor, external alar length, lateral pyramidal length and frontal pyramidal deviation's starting side. After considering and evaluating these parameters, either double lateral or high lateral osteotomy was performed on the side where the bony wall was considered to be longer.
Results
Out of 521 patients whose lateral osteotomy level was decided by applying the SELF algorithm, 493 were female, and 28 were male. The ages of the patients ranged from 18 to 59 years. Based on the SELF algorithm, 401 double lateral and 85 high lateral osteotomies were performed on the side with the longest anterior–posterior distance of the bony pyramid. No serious complications, either functionally or aesthetically, were encountered related to lateral osteotomies performed based on the SELF algorithm.
Conclusions
There is a relationship between the position of the septum at the nasal floor, external alar length, lateral pyramidal projection and frontal deviation, as the tissues in the nose are shaped in relation to each other during development. The SELF algorithm based on these parameters can provide assistance to the surgeon in terms of selecting the position and number of lateral osteotomies, especially in minimally deviated noses.
Level of Evidence IV
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References
Xia TY, Punjabi A, Oh JH, Wee C, Guyuron B (2020) Updated dynamics of rhinoplasty: a review of the literature and comprehensive list of the findings. Aesthetic Plast Surg 44(3):904–909
Cabbarzade C (2021) Septal bony paste graft: a life-saving material in rhinoplasty camouflage. Aesthetic Plast Surg. https://doi.org/10.1007/s00266-021-02560-5,September7,2021
Hafezi F, Naghibzadeh B, Ashtiani AK, Guyuron B, Nouhi AH, Naghibzadeh G (2014) Straight septum, crooked nose: an overlooked concept. Aesthetic Plast Surg 38(1):32–40
Koçak I, Senturk E (2017) Osteoplasty in crooked nose deformity: a novel approach. Aesthetic Plast Surg 41(3):628–636
Cabbarzade C (2019) A new algorithm for hump reduction according to dynamics of dorsal preservation. Aesthet Surg J 39(12):547–549
Cabbarzade C (2020) A new practically designed punch for preservation rhinoplasty. Plast Reconstr Surg Glob Open 8(2):2656
Cabbarzade C, Yücel ÖT, Sözen T, Ozgen B (2021) External splinting is not mandatory after all rhinoplasties: a prospective randomized trial. Ann Plast Surg 86(4):376–380
Murakami CS, Larrabee WF (1992) Comparison of osteotomy techniques in the treatment of nasal fractures. Facial Plast Surg 8(4):209–219
Bloom JD, Immerman SB, Constantinides M (2011) Osteotomies in the crooked nose. Facial Plast Surg 27(5):456–466
Kuran I, Ozcan H, Usta A, Bas L (1996) Comparison of four different types of osteotomes for lateral osteotomy: a cadaver study. Aesthetic Plast Surg 20(4):323–326
Guyuron B, Behmand RA (2003) Caudal nasal deviation. Plast Reconstr Surg 111(7):2449–2457
Ghassemi A, Prescher A, Hilgers RD, Riediger D, Gerressen M (2011) Effect of the sequence of lateral osteotomy and hump removal on the aesthetic outcome. Aesthetic Plast Surg 35(4):603–607
Sajjadian A, Guyuron B (2010) Primary rhinoplasty. Aesthet Surg J 30(4):527–539
Bracaglia R, Fortunato R, Gentileschi S (2004) Double lateral osteotomy in aesthetic rhinoplasty. Br J Plast Surg 57(2):156–159
Parkes ML, Kamer F, Morgan WR (1977) Double lateral osteotomy in rhinoplasty. Arch Otolaryngol 103(6):344–348
Mottura AA (2011) Internal lateral nasal osteotomy: double-guarded osteotome and mucosa tearing. Aesthetic Plast Surg 35(2):171–176
Cabbarzade C (2019) A promising new technique for correcting a deviated nose: partial disarticulation of keystone area. J Craniofac Surg 30(8):2586–2589
Stepnick D, Guyuron B (2010) Surgical treatment of the crooked nose. Clin Plast Surg 37(2):313–325
Cabbarzade C (2021) Mucoperichondrial spreader flap application for middle vault reconstruction in rhinoplasty: a review of 857 cases. Aesthet Surg J 41(6):701–705
Cabbarzade C (2020) A novel tip suture technique in rhinoplasty: lateral crus caudocephalic rotation suture. Eur J Plast Surg 43(3):313–322
Inanli S, Binnetoglu A (2016) A combined approach to crooked nose deformity. Aesthetic Plast Surg 40(3):360–366
Demir UL (2019) A novel approach to crooked nose in rhinoplasty: asymmetric level osteotomy combined with unilateral spreader graft. J Craniofac Surg 30(5):1512–1515
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Dr. Cavid Cabbarzade has nothing to disclose. No funding was received for this article.
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Cabbarzade, C. SELF: A Novel Algorithm for Deciding the Position of Lateral Osteotomies in Rhinoplasty Patients with Minimal External Deviation. Aesth Plast Surg 46, 1848–1857 (2022). https://doi.org/10.1007/s00266-022-02791-0
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DOI: https://doi.org/10.1007/s00266-022-02791-0