What is the typical duration of a lateral osteotomy (bone cutting procedure) percutaneous (through the skin) procedure to correct a stairstep deformity after rhinoplasty (nose surgery)?

Duration of Percutaneous Lateral Osteotomy for Correcting Stairstep Deformity After Rhinoplasty

A percutaneous lateral osteotomy to correct a stairstep deformity after rhinoplasty is typically a brief procedure, taking only a few minutes to perform when executed by an experienced surgeon. While the guideline literature does not specify an exact duration, the procedure is designed to be minimally invasive and efficient.

Technique Overview

The percutaneous lateral osteotomy is performed with these key considerations:

• The osteotomy is executed through small skin punctures rather than through endonasal approaches
• It uses the smallest possible osteotomies to achieve the desired mobilization while preserving periosteal and mucosal attachments 1
• The procedure follows a specific path:
  • Starting on the piriform aperture, just above the attachment of the turbinate
  • Sliding low over the nasofacial groove to prevent step-off deformities
  • Ending high on the nasal bone at the level of the medial canthus 1

Advantages of Percutaneous Approach

The percutaneous approach offers several benefits that contribute to its efficiency:

• Better bone healing compared to endonasal techniques 2
• Less bone and periosteal trauma 2
• Controlled fracture patterns that help prevent additional step-off deformities 1
• Preservation of the triangular strut of maxillary bone for midvault stability 3

Correcting Stairstep Deformities

For stairstep deformities specifically:

1. The surgeon identifies the location of the deformity
2. Performs precise, controlled osteotomies to mobilize the bone
3. May use small transverse percutaneous puncture-type osteotomies for adequate mobilization 1
4. In cases of unstable osteotomies or persistent step-off deformities, fixation techniques such as cerclage wire may be employed 4

Important Considerations

• Avoid intermediate osteotomies halfway up the nasal bone as they risk visible irregularities or step-off deformities, especially where skin covering is thin 1
• Preserve periosteal attachments whenever possible to maintain stability of the nasal framework 1
• Consider camouflaging techniques in addition to osteotomies when complete correction cannot be achieved through osteotomies alone 1
• Be cautious with short nasal bones as they are a relative contraindication for osteotomies due to risk of bony communication 1

Potential Complications

• Visible irregularities if performed improperly
• Destabilization of the nasal framework if periosteal attachments are not preserved
• Inadequate correction if the osteotomy is not properly positioned

The percutaneous approach has been shown to result in less postoperative ecchymosis and edema compared to other techniques 5, which contributes to better patient outcomes in terms of morbidity and recovery time.