Osteotomies and Dorsal Hump Reduction in Rhinoplasty: Review of Techniques and Complications

Introduction: Techniques in rhinoplasty can be challenging for trainees and novice surgeons to fully understand, especially given numerous sensitive structures that are often not fully visualized intraoperatively. Herein, we seek to use cadaver models to perform numerous rhinoplasty techniques with associated deformities. In particular, we seek to demonstrate proper osteotomy technique, which can be especially nebulous for trainees, and clearly unveil the underlying bony changes created with medial and lateral osteotomies with the unique perspective of direct visualization of the nasal bones following skin removal. Materials and Methods: Two cadaver heads were used for the purposes of teaching dissection techniques shown in the video. Numerous surgical techniques and associated anatomical changes are shown both with skin-on and skin-off for complete understanding of the underlying structures. This study was deemed exempt from IRB approval; all images shown within the video are without identifiable patient information. Results: We visually demonstrate multiple vital concepts critical to rhinoplasty. Dorsal hump reduction is shown along with the relationship of spreader grafts in this setting given the narrowing of the internal nasal valve that results from removal of the wider dorsal cartilaginous septum. We also describe and show proper medial and lateral osteotomy technique. The high-low-high method for lateral osteotomy, as well as the use of percutaneous lateral osteotomies, is performed. Open roof deformity, inverted V deformity, greenstick fracture, and rocker deformity are discussed and visually demonstrated in a skin-off fashion. Conclusions: Surgical techniques in rhinoplasty and associated underlying anatomical changes can be challenging to fully understand. We have performed numerous core techniques, especially osteotomies, to help trainees and novice surgeons better understand the relationships between surgical techniques and their structural outcomes. IRB/Ethics Approval: The Mass General Brigham IRB confirmed that this work does not meet the criteria for human subject research and thus was exempt from IRB approval. The authors confirm that none have any commercial associations to disclose in connection with the submitted video. Runtime of video: 6 mins 14 secs