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Open access peer-reviewed chapter
By Nikolay P. Serdev
Reviewed: November 30th 2015Published: March 9th 2016
The purpose of digital fracture versus lateral osteotomies is to narrow the bony base of the nose after the dorsal correction, by closing the open dorsal roof, avoiding the lateral “rocker” or steplike deformities. The author presents the digital fracture technique, which is simple, safer, closes the open dorsal roof after medial osteotomy much better, and does not provoke bleeding and bruising. It is atraumatic and saves time during the operation and recovery.
Lateral osteotomy, internal or external, or in different levels, has some negatives that can lead to single or multiple reoperations. Its main complications are: unnatural contour of nasal bones; visible and palpable bony step, collapse of the upper lateral cartilages, along with infection, bleeding, massive edema, anosmia, lacrimal duct injury, intracranial injuries, disfigured appearance, narrow airway, and nasal obstruction. It is very difficult to reverse a lateral osteotomy and revision may end up with more of a flat top or square top nose, known as an open roof deformity [1, 2].
Choosing a method for closure of the open dorsal roof after medial osteotomy must be balanced with the other features and characteristics of the nose. In this regard, “digital fracture” has many advantages over lateral osteotomy – it is much more precise in closing the dorsal roof, without danger of bleeding, step formation, collapse of the upper lateral cartilages, and nasal obstruction. It is performed easily in any type of nose. The author has not observed any complications connected to this technique [3, 4].
The author applies the digital fracture technique after medial osteotomy and hump removal, in primary as well as in secondary cases. It is performed by applying lateral pressure on the nasal bone in its dorsocaudal end, using the thumb. The other hand fixes the head with opposite pressure (Figure 1). There is a very small percentage of difficult digital fractures, mostly in men with thick nasal bones. A skin-colored tape is used for 3 days to reduce the swelling – the glue of the tape is hypertensive and partially absorbs the edema (Figure 2).
The technique has been used in all cases of author’s rhinoplasties with humpectomy, under local anesthesia, since 1994. It gives a very natural result in all primary cases, as well as in secondary cases. It saves time, there is almost no bleeding and trauma is minimal Thus, downtime is shortened.
In all of author’s chapters, results after humpectomy show the result of digital fracture as well.
Due to the lack of trauma, there is no post-op bruising in 30% of the cases with medial osteotomy and digital fracture.
Bruising is observed in nearly 70% of the cases. It is mostly linear along the tear through and disappears in a week (Figure 3).
Digital fracture is superior to lateral osteotomy. It is a very simple technique, atraumatic, takes only some minutes to perform, prevents from bleeding and shortens downtime. It prevents surgeons and patients from all possible lateral osteotomy complications and has no known complications itself.
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Authored by Nikolay Serdev
By Nikolay P. Serdev
Edited by Nikolay Serdev
By Diego Schavelzon, Louis Habbema, Stefan Rapprich, Peter Lisborg , Guillermo Blugerman, Jorge A. D’Angelo, Andrea Markowsky, Javier Soto, Rodrigo Moreno and Maria Siguen
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