Nasal osteotomy and airway changes.

The purpose of this prospective investigation was to evaluate the factors involved in the constricting effect of nasal bone osteotomy on the nasal airway. Immediately before the osteotomy, observations were made and recorded in regard to both the position of the inferior turbinates and the length of the nasal bones. During the osteotomy, the nasal bone movement was graded and the type of osteotomy was documented. The two types of osteotomy were defined as either high-to-low or low-to-low. Each side of the nose was assessed independently. Forty-eight consecutive patients, 8 men and 40 women, were included in this study, providing 96 nasal sides for evaluation. There were 42 normal, 32 short, and 22 long nasal bones. The patients with short nasal bones exhibited less diminution in the airway than those patients with normal nasal bones (p < 0.05). The position of the inferior turbinates was designated as anterior in 48 sites, 12 were considered normal, and 28 were deemed posterior. The narrowing of the airway was significant when the inferior turbinates were positioned anteriorly when compared with posteriorly positioned inferior turbinates (p < 0.05). Twenty-four nasal bones were shifted slightly, 48 intermediately, and 22 significantly. Major nasal airway constriction was observed when the medial positioning of the nasal bone was significant (p < 0.05). Eighty-four osteotomies were classified as low-to-low, and 12 were high-to-low. High-to-low osteotomies resulted in the least narrowing of the nasal passage (p < 0.005). It is concluded from this study that the nasal osteotomy does constrict the nasal airway in most incidences. The length of the nasal bones, the degree of nasal bone repositioning, the position of the inferior turbinates, and the type of osteotomy are definite factors contributing to airway narrowing after nasal bone osteotomy.