Nasal Bone Surgery
Overview
Nasal bone surgery collectively refers to procedures that surgically correct the shape and function of the nasal bone (비골), located at the center of the face, and the cartilage and soft tissue surrounding it. Its scope is broad, ranging from reduction of nasal bone fractures caused by trauma to correction of a hump nose or crooked nose and improvement of nasal obstruction due to septal deviation. Because the nose is involved in both respiratory function and appearance, the principle is for plastic surgery and otolaryngology to collaborate in setting both cosmetic and functional goals.
Key Details
Anatomical Structure
The nasal bone is a small, thin bone consisting of a pair on the left and right; above, it connects to the nasal spine of the frontal bone, and laterally to the frontal process of the maxilla. Because it is the most protruding part of the face, it is highly vulnerable to trauma. The upper third of the nose is composed of bone, the middle third of septal cartilage and upper lateral cartilage, and the lower third of lower lateral cartilage (alar cartilage). Therefore, nasal bone surgery should be understood not as simple bone surgery but as complex surgery encompassing bone, cartilage, and skin.
Indications
- Traumatic nasal bone fracture: Closed reduction is usually possible within 2 weeks; after that, the fused bone must be re-osteotomized.
- Cosmetic nasal deformity: Hump nose, crooked nose, low nasal bridge, upturned nose, etc.
- Functional problems: Nasal obstruction due to deviated nasal septum, snoring, chronic rhinitis, recurrent sinusitis.
- Others: Congenital facial malformations, sequelae of cleft lip and palate, reconstruction after tumor resection.
Surgical Methods
1. Closed reduction: A method of pushing the fractured fragment back into place through the nasal cavity; it is mainly performed for acute fractures and leaves no scar.
2. Open reduction: The columella (nasal column) is incised to directly view the fracture site, accurately align it, and fix it. It is used for complex fractures or when facial bone fractures are accompanied.
3. Nasal bone osteotomy: A procedure that narrows or straightens the nasal bone through medial and lateral osteotomies, and is central to correcting a crooked nose and a wide nose.
4. Augmentation rhinoplasty: Surgery to raise the height of the nasal bridge, using implants or autologous tissue.
5. Septoplasty: Straightens a deviated nasal septum to improve breathing, and is also used as a donor site for autologous cartilage.
6. Materials used: Artificial implants such as silicone, Gore-Tex, and PEEK, and autologous tissues such as septal cartilage, auricular cartilage, rib cartilage, and dermofat. Recently, the preference for autologous tissue has been increasing.
Preoperative Evaluation
Facial computed tomography (CT) and Waters view plain radiography are used to confirm the fracture pattern and sinus condition, and nasal endoscopy is used to observe the nasal septum and mucosa. Frontal, lateral, and oblique photographs and 3D scans are used to analyze asymmetry, and history of aspirin/anticoagulant use, allergies, hypertension, diabetes, and smoking must be checked.
Anesthesia and Operative Time
Local anesthesia with sedation or general anesthesia is performed. Simple closed reduction takes about 30 minutes, while complex surgery combining osteotomy and augmentation rhinoplasty takes about 2–3 hours.
Recovery and Complications
After surgery, swelling and bruising are severe for 2–3 days and improve over 1–2 weeks. The splint for nasal bone fixation is often removed after 5–7 days, and sutures after 5–7 days. Major complications include bleeding, infection, nasal stenosis, septal perforation, decreased sense of smell, implant displacement, recurrence, and asymmetry; rarely, implants or fillers can enter blood vessels and cause ocular complications such as vision loss or blindness, requiring immediate response. Smoking cessation, blood pressure management, avoiding glasses, and not blowing the nose are important for recovery.
Recent Trends
As of 2024–2025, the field of nasal bone surgery is being reorganized around precision, minimally invasive techniques, and autologous tissue. Ultrasonic osteotomy (piezo) is spreading as a method that reduces soft tissue damage and finely refines bone fragments to shorten recovery time. Patient-specific implants using 3D printing and PEEK materials, AI-based facial ratio analysis, and virtual surgical simulation have been introduced at the surgical planning stage, increasing the accuracy of outcome prediction. The preference for implant-free rhinoplasty (autologous cartilage and dermofat grafting) has become pronounced, and septal rhinoplasty that addresses both function and appearance has become close to standard. Postoperative fast-recovery protocols, absorbable fixation materials, and pain control protocols have also become common, and the criteria distinguishing correction of functional problems such as deviated nasal septum, which is covered by health insurance, from purely cosmetic purposes, which are not covered, continue to be maintained.
Related Topics
- [[Deviated nasal septum]]
- [[Nasal bone fracture]]
- [[Augmentation rhinoplasty]]
- [[Plastic surgery]]
- [[Otolaryngology]]