The oscillating micro-saw: a safe and pliable instrument for transverse osteotomy in rhinoplasty.

Abstract

A low-to-low lateral osteotomy combined with a transverse osteotomy offers a reliable technique to mobilize the lateral walls in patients with broad bony vaults, but variable "brittling" characteristics of the nasal bones near the radix make it difficult to guarantee the result of manual transverse osteotomy. The author describes a split-thickness transverse osteotomy with the aid of an oscillating micro-saw under video/endoscopic control to eliminate the risk of probable pitfall fractures on the structure of the bony nasal vault near the radix during blind manual osteotomy. The author reviewed 1550 consecutive rhinoplasty and septorhinoplasty operations performed between April 2005 and October 2010. Among these the transverse osteotomy was used bilaterally in 1374 cases. Split-thickness transverse osteotomy was carried out with a powered micro-saw system from an endonasal approach under video/endoscopic control. CT-based 3D models of 16 patients with different functional indications were used to assess the mean depth of the transverse osteotomy line. The mean depth of the nasal wall at the thickest point of the transverse osteotomy line near the radix was 2.5 ± 0.66 mm. It decreased toward the medial canthus in all 16 patients. The mean thickness of bone was 1.2 ± 0.21 mm in the medial canthal area. The oscillating micro-saw is a safe and pliable instrument to aid in transverse osteotomy during rhinoplasty. Video endoscopy provides an excellent view of the osteotomy site, including direction and depth, in addition to providing documentation for and education about the procedure.