Comparative study between internal and external osteotomy in rhinoplasty

Abstract

Background: The aim of this study is to compare between internal osteotomy and external osteotomy in patients undergoing rhinoplasty. Methods: The study involved 50 patients, 25 of them had external percutaneous lateral osteotomy, the other 25 patients had internal endonasal lateral osteotomy. The internal osteotomy was done low to high using 4 mm. curved guarded osteotome. The external osteotomy was done low to low using 2 mm sharp osteotome. The grading system of Kara and Gokalan was followed for edema and ecchymosis. Results: The mucosal tear is found in 4 patients of group - A (those who had external osteotomy). (16%), while 20 patients of group-B (those who had internal osteotomy) (80%) had injury to nasal mucosa. In group-A patients only 5 patients (20%) develop periorbital oedema, all were of Grade 2. All the patients of group-B (100%) develop periorbital edema, 2 patients (8%) of grade 4 edema, 10 patients (40%) of grade 3 edema, 12 patients (48%) of grade 2 edema and one patient (4%) of grade 1 edema. The ecchymosis of grade 1 was found in 3 patients of group-A (12%) and in 20 patients of group-B (80%). Conclusion: External osteotomy is preferred over internal osteotomy with less complication rate. It causes much less mucosal injury and significant reduction in periorbital edema and ecchymosis without scar formation.