During rhinoplasty, there are several techniques to cosmetically perfect the nose and improve breathing. The nose is mostly bone and cartilage. The top of the nose just below the brow (bony vault) is composed of bone and the lower part of the nose is composed of cartilage. There are times when the nasal bones are broken during the surgery. This does not always happen during rhinoplasty, but when done, it can increase bruising and discomfort during recovery.
Will the Doctor Break My Nose During My Rhinoplasty?
This is a question we hear daily at our center in Newport Beach. The fact of a broken nose strikes fear into the average person. So, let’s dispel some myths.
Osteotomy does not mean we put you to sleep and whack you in the nose with a rubber mallet. Osteotomy is a precise and exact incision into the bone to narrow or straighten certain areas. The instrument used is an osteotome, which cuts the bone, it does not break it. This can be compared to an incision with a scalpel as opposed to the tearing of the skin. The process is one of precision with your comfort and optimal results at the forefront.
When there is a deviation to the left or right of the bony facet of the nose, then the bone will need to be fractured. They are cut in a manner to be re-set in a straight fashion. The procedure is common among patients who have suffered trauma to their nose or had broken it in the past.
For instances when the nose is extraordinarily wide, and osteotomy rhinoplasty may be performed. Here the bone is fractured and repositioned in a narrower fashion in the upper area of the nose.
The most common signal for fracturing the nasal bone is to recapture the natural shape of the nose after a hump has been extracted. After a hump is removed, the natural triangle shape of the nose is altered because the bridge (tip of the triangle) becomes flat. This flat area is a result of a gap caused between the nasal bone where the hump (part of the bone) was removed during excision. The bone is then fractured to bind the nasal bone and regain the natural triangle shape. This will eliminate the rhinoplasty complication known as an “open roof”.
Osteotomy for Broken Nose Repair
A broken nose is not a pretty picture for the most part. A big bump or dent is usually the consequence, or maybe a bend to either side.
Repair of this break may involve another form of break known as osteotomy, which is a controlled method of fracturing then straightening the bone, splinting and allowing it to heal straight. Cartilage grafts may be required to fill in dents on the nasal bridge.
Nose breaks not only involve trauma to the nasal bone, but to the nasal septum as well. Damage to this cartilage framework can result in a nasal septal deviation. The main function of the nose is breathing and any deviation of the nasal septum can impair airflow and cause great discomfort. This can complicate any rhinoplasty evaluation and procedure. The surgeon must consider both aesthetic and functional damage to the nose in the surgical plan.
To repair the deviated nasal septum and the broken bone, the surgeon will make an incision inside the nose on the nasal septum, and remove the crooked part of the septum. This is called Septoplasty which can be combined with various rhinoplasty techniques.
A cartilage graft from the septum or ear cartilage may be used to reinforce the weak, deviated septum. A septoplasty is often done concurrently with a turbinectomy which removes enlarge inferior nasal turbinate that will hamper nasal airway passage.
Septoplasty and Inferior turbinectomy is often done simultaneously with Rhinoplasty when repairing nasal and septal fractures. Either open or closed rhinoplasty can be administered in repair of a broken nose. Wide Nose Osteotomy Rhinoplasty
A narrow nose is considered elegant in either gender and across most ethnicities and cultures. Narrowing the nose can refer to three areas:
- Narrow the bridge of the nose
- Narrow the bulbous tip of the nose
- Narrow flared nostrils
The wide nasal bridge is most visible with an upfront view. This problem is the thick of nasal bones. This unsightly width is treated using an osteotomy technique. This involves making controlled bone fractures which allows the nasal bones to be positioned inward thereby narrowing the appearance of the nose.
An osteotome is used to make controlled cuts in the nasal bones to mobilize the bones for bone repositioning.
Osteotomies are often made when a hump is extracted and the gap need to be filled. Once the hump is removed, a wide bridge will ensue and the nose will appear too wide. This will allow the surgeon to correct the resulting “open roof deformity” in which the bridge appears overly flat.
The Three Types of Osteotomies
The three types of osteotomy are:
- Medial Osteotomies
- Lateral Osteotomies
- Intermediate Osteotomies
Medial osteotomies are performed from the center of the bridge to the corner of the eyes. Lateral osteotomies are made along the sides of the nose, where the nose meets the cheek, Intermediate are made closer to the bridge.
Lateral osteotomies are the most commonly used. Two basic techniques for lateral osteotomies are sweeping and perforating.
An osteotome is used in a continuous high-low-high fashion for the sweeping technique. With extra wide nasal bones, a low to high osteotomy will narrow the facial width inwardly. With extremely wide nasal bones, an intermediate osteotomy may be necessary.
A perforating osteotomy creates small perforations along the nasal bones. Here a smaller osteotome will make perforations along the rising maxilla superiorly. Then in a controlled fashion, the bones are fractured. The perforated skin will heal with minimal scarring without the need for sutures.
With rhinoplasty using osteotomies, recovery will see an increase in bruising and swelling around the eyes. This will remain 3 to 4 days following the procedure, and subside within a week. Most patients look presentable after 8-10 days. Pain is mild, but you will need medication prescribed. Icing and keeping the head elevated should reduce swelling and aid in the healing process. Taking supplements like bromelain and Arnica Montana will aid in minimizing the swelling.