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Steven M. Denenberg, M.D.
Dr. Denenberg's articles on Medium.com.

Rhinoplasty tutorial >> The nasal bones >> page 6
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In this view, the skull is tilted to show the inside surface of the skull's right nasal bone and bony pyramid (shaded blue in the diagram).  The large black and white arrows are in their normal positions to show the bone cuts for the right nasal bone.  On the skull's left side, I have shown with smaller gray and green arrows the bone cuts on the left nasal bone.

This part of the rhinoplasty operation, cutting and mobilizing the bones, is called the "osteotomy," from the Greek word "osteo," meaning "bone."  It is pronounced AHSS-tee-AH-tuh-mee.  A plastic surgeon would say, "I narrowed the bony pyramid of the nose with osteotomies."


Click on any image in this tutorial to see a greatly-enlarged version
Let's see how this works on a real person.  Above we see the inside of the nose after it has been skeletonized, that is, after the skin has been released from the underlying cartilage and bone so that we can see what's going on in there.  The nasal bones, which form the bony pyramid of the nose, are colored pink.  The upper lateral cartilages, which form the cartilaginous pyramid, are colored blue, and the lower lateral cartilages, which form the tip, are green.

A 2-millimeter-wide chisel is introduced, and the first of the two cuts in the right nasal bone is being made, corresponding to the black arrow in the diagram at the top of this page.  The chisel cut starts at the midline, and extending into the bony pyramid.  In the diagram, the bone is pink and the cartilaginous pyramid is blue.

You learned a little earlier in this chapter that we remove the hump before performing the osteotomy.  You can tell that the hump has already been taken off in these pictures because we have an excellent view of the top, or dorsal surface, of the septum, highlighted in white in the diagram above right.  Compare these two images with the two pictures just above them, in the middle of the page.  In the previous two photos, which show the nose right after skeletonization but before removing the hump, the septum is not yet visible, because the hump hasn't been taken off to expose the septum yet.



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All surgery depicted in this essay, except where noted, was performed by Dr. Denenberg