Osteotomies (fracturing the nasal bones) are performed for a number of reasons in rhinoplasty. These controlled fractures of the nasal bones allow for moving and reshaping the nasal bones. It is performed by using a sharp osteotome (similar in design to a chisel) driven through the nasal bones with controlled taps with a mallet.
During rhinoplasty, the most common reason to perform osteotomies is to medialize (narrow) the nasal bones. This is necessary when the nasal bones are too wide, when there is an “open roof” deformity, or the bones are obliquely oriented. An open roof deformity is sometimes created during dorsal hump removal (removing a bump on the bridge) as the bone and cartilage is removed to lower the dorsum. In order to close this opening, osteotomies are used to bring the bones together.
Another reason that fracturing the nasal bones may be necessary is to improve the symmetry between the nasal bones. Especially after nasal trauma or a previous nasal fracture, the bones will often acquire asymmetric deformity. Controlled fractures of the bones are used to reshape the bones.
In general, osteotomies will be responsible for the majority of bruising during nose job surgery. Surgical technique does play a role in the degree of bruising after surgery, as precise, controlled osteotomies will often result in less bruising. Bruising from osteotomies can result in “black eyes” that last an average of 7-10 days.
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