Understanding Why Lateral Osteotomy During Rhinoplasty Can Be Performed Safely.

Lateral osteotomy is a mainstay of rhinoplasty surgery and involves fracture of the nasal and maxillary bones to narrow or widen the nasal dorsal bridge and base. To avoid nasal midvault collapse following rhinoplasty, the accepted "high-low-high" lateral osteotomy technique advocates for the preservation of a triangular strut of maxillary bone when initiating the osteotomy. We evaluated the risk of starting a lateral osteotomy in the "high" position to leave the aforementioned triangular maxillary strut without risk of falling into the nasomaxillary suture line, which can result in an aberrant and uncontrolled fracture. We utilized high-definition computed tomographic scans to reconstruct layered 3-dimensional images of 20 patient skulls and measured the distance from the rhinion (most inferior point of the central nasal bone junction) to the nasomaxillary suture line and from the rhinion to the maxillary groove. We found that the nasomaxillary suture line was reliably only halfway down the bony nasal pyramid and not in proximity to the maxillary groove. Our findings provide reassurance that a generous triangular strut can be preserved along the maxillary component of the piriform aperture without concern of falling into the nasomaxillary suture line. Thus, controlled lateral osteotomies can be performed safely to achieve aesthetic gains without fear of compromising midvault stability.