How to break the nose during rhinoplasty with osteotomies

Thomas Lamperti, MD discusses how osteotomies are made during rhinoplasty to fracture and mobilize the nasal bones. This can be done to treat either a crooked nose or wide bridge. He first shows a schematic outlining where the controlled bone cuts are made. Next an intra-operative video of actual rhinoplasty surgery showing medial and lateral osteotomy placement is presented. You can also see what an osteotome (a medical grade chisel) looks like.

Video Transcript:

"This is Doctor Thomas Lamperti. I'm a Seattle facial plastic surgeon. Today I'm going to talk about how we re-break the nose during rhinoplasty using osteotomes. This figure shows where we actually place the bone cuts to make the controlled bone fractures. The inner path is the medial osteotomies and the lateral osteotomies are on the outside portion. And here is an intra-operative view of me making medial osteotomies to help straighten a patient's crooked nose. You can see that the osteotome is a small device and it is essentially a very fine medical grade chisel. We very incrementally and in a very controlled fashion make these bone cuts to free up the bones in the midline. We make the cuts first on one side and then repeat the cuts on the other side to free up those bones as well.

Here's a photograph of an osteotome. This is a curved, guarded osteotome that we usually use for lateral osteotomies. And here we are now making the lateral osteotomies in the same patient. We can see that the surgical assistant uses a mallet to help me tap the osteotome. As you can see there is not a whole lot of force needed to do the bone cuts. The osteotomes are quite sharp and allow us to mobilize the nasal bones in a very controlled fashion. Many people presume that we re-break the nasal bones in a less refined way. Perhaps just using a hammer to hit the nose or something like that? One goal of this video is to show how rhinoplasty surgeons actually do re-break the nasal bones. Prior to doing the lateral osteotomies I do use a different surgical tool to free up the soft tissue around the bone to lift it off of the bone. This helps to minimize the soft tissue trauma during the procedure. It also helps to minimize bruising afterwards as well."