The relationship of lateral osteotomies in rhinoplasty to the lacrimal drainage system.

Damage to the lacrimal drainage system is a potentially complicating factor in rhinoplasty utilizing lateral osteotomies. The authors present data from osteotomies performed on a series of fresh cadavers. Following completion of the osteotomies, the lacrimal sac and nasal lacrimal ducts were identified and cannulated. Soft tissue was dissected to demonstrate the osteotomy site. The specimen was inspected to delineate involvement (if any) of the lacrimal duct or sac. The proximity of the osteotomy site to the lacrimal drainage apparatus components was measured in each specimen. Various parameters were observed, including the effect of curved vs. straight osteotomies, guarded vs. unguarded osteotomies, and the effect of various widths of osteotomies. Likewise, the degree of risk to the lacrimal system was evaluated, and the technique of the novice and resident surgeon was compared to that of the experienced rhinoplastic surgeon. A low, curved osteotomy, performed with a sharp osteotome without subperiosteal tunnels, provides the safest maneuver. Lateral osteotomies, properly performed, prove to be an unusual cause of lacrimal drainage dysfunction.