Rhinoplasty with nasal bone disarticulation to deepen the nasofrontal groove. Experimental and clinical results.

Deepening of the nasofrontal groove is considered a fiddly task. The unwonted chisel ostectomy technique (Skoog, 1974; McCarthy, 1990; Aiach and Levignac, 1991) was therefore modified and evaluated both experimentally and clinically. The hump is removed in one piece together with the nasal bones up to the horizontal part of the frontonasal suture. To accomplish this, the reduction osteotomy has to be performed in a wave line fashion. The depth of resection in the sellion area depends upon the aesthetic planning. In cases with most severe hypertrophy, the osteotome enters the vertical frontonasal suture behind the nasal bones and in front of the nasal spine of the frontal bone. The nasal bones are disarticulated with a levering movement. Cadaver studies demonstrate the safety of the technique: no fracture lines were detected in the frontal process of the maxilla, ethmoid, frontal or lacrimal bones, by either clinical inspection, or by standardised radiological examination. The clinical cases show a convincing outcome.