Double-Guarded Osteotome for Internal Lateral Nasal Osteotomies to Prevent Mucosa Tearing

Abstract

For the internal lateral nasal osteotomy, a 4-mm double-guarded straight osteotome is described that separates the external periosteum and mucoperiosteum while the osteotomy is progressing. As the sharp part is behind the guards, it is not possible for the osteotome to slip away laterally or medially from the nasal bone.

Before the osteotomy, the external periosteum and the internal mucoperiosteum are infiltrated with local anesthesia and elevated by tunneling with an elevator. By tunneling just at the base of the nasal bones, arteries, veins, and lymphatics are preserved, while the superior part of the external periosteum and the internal mucoperiosteum maintains the bones stable with a firm support on both sides. In general, minor lower lid edema and ecchymosis were observed related possibly to the fact that the periosteum was elevated, thus preserving the supraperiosteal arteries, veins, and lymphatics. When the mucosa was elevated, the internal irrigation of the mucosa and the lymphatics was also preserved, thus avoiding intraoperative bleeding, intranasal packing, and postoperative bleeding.