Medial Osteotomies are placed in the nasal bones to narrow the top of the nose and close the open roof created from the hump removal. Lateral osteotomies performed to narrow the base of the nose. both are usually required. Performing osteotomies does not compress or squeeze the nasal septum.
If you think of the septum as a midline structure like a pole adjacent to the side walls of a tent ( the bones) than you will understand that the septum will not be squeezed by the osteotomies.
When complete osteotomies done after hump removal, the lateral walls are not firmly attached to anything but the overlying skin. A splint will hold the bones in proper position, against the top part of the septum, closing the open roof.
Hello and thank you for your excellent question. Osteotomies are performed in order to lessen the width of the mid-nasal vault or to correct an open roof deformity after a dorsal hump reduction. When osteotomies are performed, the bones do come to the center, but do not harm or squeeze the dorsal septum.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon
Your question is very insightful. When bones are narrowed through osteotomies, they do move towards the septum, narrowing the airway, but not in a damaging way to squeeze it. One fact you may not know is that, when you take down a dorsal hump, it creates a gap between the bones and the septum, called an open roof. Osteotomies close the open roof, a necessary intervention. From an airway standpoint, spreader grafts prevent the bones from over-narrowing the airway. The cartilage middle third is most important for breathing. This helps prevent airway obstruction from osteotomies.
The analogy given previously is exactly the analogy I use with my patients. The osteotomies are used to re-create the triangular relationship of the nasal bone with the septum dividing the triangle down the middle. If osteoporosis were not performed, you can imagine chopping off the top of a mountain...you would have a plateau.
Imagine that when you are lying flat, the nose is like a tent; the nasal bones are the walls of the tent, and the septum is the divider (pole) that holds the tent up. Therefore the bones meet the septum at the triangle at the top. Osteotomies often bring the walls of the tent closer together, but the triangle at the top still remains the same. Even if a large hump is removed, the nasal bones are repositioned so that the triangle is recreated without damaging the septum. Hope this analogy helps!