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OSTEOTOMIES
Aims
  1. Mobilization and repositioning of the lateral nasal bones to achieve the desired satisfactory position.
  2. Prevention of open roof deformity.
Types
  1. Medial Osteotomies.
  2. Lateral Osteotomies.
Additional Osteotomies: This may be needed in crooked noses:
  1. Intermediate osteotomies.
  2. Transverse osteotomy.
Techniques: We use the following techniques:
  1. Medial Osteotomies
    1. The instrument used is Masing's single guarded osteotome:
      Right curved, left curved and straight. (Fig. 17 - 4)
    2. Usually performed after hump removal or even without hump removal if needed to narrow the bony pyramid. (Fig. 17 - 18)
    3. Start with left single guarded Masing's osteotome on the left side, push the osteotome between the upper lateral cartilage and nasal septum until it reaches the osteocartilagenous junction, try to be as close to the midline as you can. Start tapping and while the osteotome is moving cephalically guard it with your index finger and direct it towards the medial canthus curving laterally. This leaves a more natural root to the nose and avoids cribriform plate injury. Then repeat the same on the right side. (Figs. 7 - 1,2)
  2. Lateral Osteotomies
    1. Cottle's two mm osteotome is used.
    2. The osteotomy is carried out via an external stab incision (Bull's technique).
    3. Push the osteotome into the small stab incision and create a subperiosteal tunnel. The tunnel should be as close to the face as possible starting at the inferior border of the bony pyramid one millimeter above the face and moving up cephalically along the desirable path to meet the cephalic end of the medial osteotomy which has already been performed. (Figs. 7 - 1,2)

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