Hi, I broke my nose in '05 when I got punched outside a nightclub. The impact was from the right side. It was reset but broken during sports a few months later. I am scheduled for septorhinoplasty in july but was wondering if it is possible for this to be done(osteotomies)without narrowing the dorsum because I like the width, just not the orientation, its crooked. Thanks very much. Basically, is it inevitable for some narrowing, I really dont want any.Kind regards
Do Osteotomies Always Cause Narrowing?
Doctor Answers 2
Osteotomies can bring the nasal bones out as well
Osteotomies are cuts made in the bone, usually made with bone cutting instruments called osteotomes. The idea is to mobilize the nasal bone(s), and place it ot them, in a position to heal after the surgery. Most often the osteotomy is done too narrow & straighten the nose, but can also be done to place the nasal bone outwards, called an out-fracture. As you mentioned, a broken nose is the most common reason to move the bone outwards.
In our office, we use video imaging to simulate the shape changes with rhinoplasty. We use these images as a road map to attempt to educate the patient, and to show what I, as the surgeon, am trying to accomplish - knowing that there are many variables which affect the surgery & the healing.
Only one side can be fractured in crooked noses
If your bony nose (the upper third) is crooked, I usually only fracture the bone that has been pushed out, which will make the nose slightly (but minimally) narrower but still make the nose more symmetrical. If septal surgery is also being done at the same time (especially after two fractures), performing only one osteotomy is also safer.
If the middle third alone is crooked, that is the septum and osteotomies may not be needed at all.