V.B. Rasping

Reducing or smoothing the bony hump may be undertaken with a surgical file or rasp. This is a com­monly used approach. Some surgeons—including the author—use a powered rasp because they feel it is more precise. These surgeons believe that with time the use of the powered rasp will increase as awareness grows. The author made great efforts worldwide to popularize the use of powered instrumentation for rasping in rhinoplasty.9

V.C. Osteotomies

Osteotomies refer to "cutting" or "breaking" the na­sal bones. This is not necessary in all rhinoplasties.

Osteotomies are typically necessary when the nasal hump has been reduced. They are also often neces­sary to narrow an over-wide nose or to improve a twisted nose.

There are several approaches to osteotomies; one approach is described here (Fig. 20).

The bone is cut in the middle with a "back cut" known as a medial osteotomy. Then, a small bone knife or osteotome is placed at the edge of the bone as shown. A gentle tap-tap technique is used to advance the osteotome along the planned path, outlined in this diagram. Now the bone is cut and may easily be shifted as needed.

Becker et al. have described small specialty osteo­tomes for minimally traumatic osteotomies.¹² Re-search has suggested that these "Becker" osteotomes and other osteotomes of similar small size are less traumatic than larger, bulkier osteotomes and may result in less bruising and faster healing time.

FIGURE 20. The bone is cut in the middle with a "back cut" known as a medial osteotomy (a). Then, a small bone-knife or osteotome is placed at the edge of the bone as shown (b). A gentle tap-tap technique is used to advance the osteotome along the planned path, outlined on the diagram. Now the bone is cut and may easily be shifted as needed.

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