The intraoral approach to lateral osteotomy: the role of a diamond burr.

UNLABELLED: Lateral osteotomy is one of the most traumatic but critical steps in rhinoplasty and can dictate the aesthetic and functional outcomes. Many techniques and instruments to perform it have been suggested, with the objectives of increasing predictability, reliability, and easiness of this invasive approach. We used a 1.5-mm diamond burr via an intraoral approach to thin out the base of the nasal wall along the nasofacial crease in 24 patients. This technique was performed in patients seeking primary rhinoplasty (n = 6), correction of cleft nose deformities (n = 4), deformities due to trauma (n = 9), and secondary nose correction (n = 5). A high mucosal incision paranasally allowed easy access to the osteotomy line. The digital in-fracturing could be performed with light pressure and without extensive manipulation at any time during the rhinoplasty. The osteotomy took on average of 14.5 min (range = 11.00-19.80) and endoscopic examination showed no mucosal tearing. Postoperative swelling and hematoma were comparable to those of other techniques. Using a diamond burr via an intraoral approach is an easy, safe, and reliable method leading to predictable outcomes. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .