Comparison of rate and severity of nasal mucosal tear with internal and external lateral nasal osteotomy using endoscope

Abstract

A precise and reproducible lateral osteotomy is a necessity for successful rhinoplasty. Generally, two basic techniques have been introduced: the external perforated method and the internal continuous method. There is an ongoing debate in the literature on the appropriateness of each method in terms of post-operative complications and patientsE satisfaction. Nasal mucosal tear is a key element in this comparison. This study was designed to compare the two techniques using a blinded endoscopic evaluation of the nasal mucosal tear after the osteotomies were performed by one of these two techniques. Methods & Materials In a randomized clinical trial, 30 candidates for elective nasal surgery (aged 20-30 years) were studied in Tabriz Imam Reza Teaching Center during a 12-month period. Each patient underwent an external lateral osteotomy performed on one side and an internal lateral osteotomy performed on the alternate side by a specialist with experience in the use of both types of osteotomy. In a blinded manner, another investigator used nasal endoscopy to detect nasal mucosal tears and reported them in millimeter (mm). Data were Analyzed using Mann-Whitney U-test and Paired T test. Results A total of 30 patients, 10 males and 20 females with the mean age of 26.473.36 years (20-30) were enrolled in this study. Nasal mucosal tear was reported in all patients with internal lateral osteotomy, whereas this rate was 90% in the other group (p=0.24, odds ratio=1.11, 95% confidence interval=0.99-1.25). The median length of the mucosal tears was 9 mm (Interquartile range, IQR= 2) in the cases with internal osteotomy vs. 4 mm (IQR=1) in the patients with external approach. The difference was statistically significant (p<0.001). The intra-group analysis stratified by the patientsE age and sex revealed a significant association neither with frequency nor with severity of the nasal mucosal tears. Conclusion This study showed that internal osteotomy, as compared with external technique, is along with significantly more severe nasal mucosal damage in patients undergoing elective nasal surgery.