We read the valuable work by Erisçir and Tahamiler (Aesthet Surg J 2008;28:518–520). The authors compared two methods of osteotomy in 72 osteotomy sides of 36 patients and, in their Conclusion, they stated that the use of a 2-mm osteotome is less traumatic and delivers the best cosmetic results.
There are many other articles that compare osteotomy methods and each of them shows a preference of one method over another. It is surprising that none of these studies has convinced the surgeons to stop using some methods and unanimously accept one technique.
We wish to address a number of important issues raised in the aforementioned article1 that may be of help in understanding some of the factors that cause so much controversy in similar studies:
(1)All right-side osteotomies in this study were performed with a 2-mm, V-shaped osteotome and all left-side osteotomies were performed by a 4-mm straight Cottle osteotome. Surgical techniques usually work differently on right and left sides of the operation, depending on the dominant hand of the surgeon, and it is logical to perform the techniques randomly in left and right sides to reduce this error.
(2)Edema and echymosis are two parameters that have been considered to compare the two methods. It is clear that postoperative edema and ecchymosis are not affected only by technique of osteotomy.1 It is also necessary to emphasize that even the worst cases of edema resolve in a few days and there are more important factors that guide us to choose the technique, such as the predictability of fracture lines, prevention of the collapse of the nasal bones, and controlled osteotomy lines along with other factors.2
(3)A smaller osteotome rationally reduces trauma, but in our opinion, it is very difficult to perform the osteotomy with a 2-mm osteotome when we consider that the nasal bone is wider than 3 mm in at least some areas.3, 4
(4)Like most other surgical maneuvers, lateral osteotomy follows a learning curve and the experience of the surgeon is crucial both in postoperative ecchymosis and the quality of the osteotomy. This is one of the main reasons that some surgeons find their chosen technique superior to some other techniques in their studies.
Finally, we think that choosing the osteotome and osteotomy technique is a complex subject that is influenced by many factors, such as experience of the surgeon and the nasal bone anatomy. We suggest considering these parameters in designing future studies.
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