Armando Boccieri Æ Michele Pascali Æ Carlo Macro
The atraumatic septorhinoplasty
Received: 28 February 2005 / Accepted: 16 June 2005 / Published online: 12 August 2005
Ó Springer-Verlag 2005
Abstract While a large number of studies have been
published on the surgical techniques used to obtain
optimal functional and esthetic results in the ﬁeld of
septorhinoplasty, less attention has been devoted to
techniques for minimizing postoperative trauma. In this
connection, the authors highlight a number of intraop-
erative methods, such as microosteotomy, extramucosal
approach, hemostasis, careful suture placement, and
endonasal splints, the use of which has led to an overall
improvement in postoperative recovery and swifter
attainment of esthetic objectives.
Keywords Rhinoplasty Æ Microosteotomy Æ
Extramucosal approach Æ Endonasal splint
The progress achieved in nasal surgery over the last few
years is related to improvements not only in esthetic and
reconstructive surgical techniques but also, and above
all, in postoperative recovery.
Patients who have undergone septorhinoplasty very
frequently complain in the immediate postoperative
period of severe discomfort that can largely be traced to
the use of highly traumatic techniques. The most sig-
niﬁcant problems appear to be pain, ecchymosis,
hematoma, edema, bleeding, lacrimation, and impeded
nasal respiration, which necessitate a protracted post-
operative period of absolute rest lasting many days.
Patients are thus obliged to take long periods of absence
from work and their lives are severely disrupted (Fig. 1).
The postoperative eﬀects of septorhinoplasty can,
however, be far less traumatic and the patient’s
appearance can be pleasing and socially acceptable even
on the very next day (Figs. 2 and 3). This can be
achieved through the use of atraumatic intraoperative
methods such as microosteotomy, the extramucosal
approach, hemostasis, careful suture placement, and the
use of endonasal splints.
Review of the literature
Tardy and Denneny  were the ﬁrst to propose a
gradual and conservative approach to the correction of
nasal anomalies. The performance of lateral and med-
ian-oblique microosteotomies with osteotomes of 2–
3 mm is fully in line with this atraumatic philosophy.
The extramucosal approach makes it possible to skele-
tonize the bony and cartilaginous vault in order to re-
model the proﬁle while respecting the integrity of the
underlying nasal passages. Fomon  and Cottle 
were the ﬁrst to underline the importance of detaching
the mucoperichondrium extensively from the septum
and the triangular cartilage so as to obtain better access
to these structures. Meyer  restricted the use of this
method to the more diﬃcult cases, e.g. crooked nose and
the nasal sequelae of cleft lip + palate. Anderson  was
the ﬁrst to highlight the importance of the extramucosal
method as a routine systematic approach in rhinoplasty.
Meyer also reported its routine use in both primary and
secondary rhinoplasty. Robin [19–21], Pollet and
Baudelot , Jost  and Jost et al.  adopted the
extramucosal technique and strongly emphasized its
positive aspects. Converse  and Regnault and Daniel
 have stressed the virtues of this approach, as have
Anderson and Ries .
Toriumi  regards the integrity of the mucoperic-
hondrium of the nasal passages as indispensable to
prevent inferomedial collapse of the median nasal vault
Presented at the 9th Congress of European Societies of Plastic
Reconstructive and Aesthetic Surgery—European section of
IPRAS, Rome, Italy, 20 September 2001.
A. Boccieri Æ M. Pascali (&) Æ C. Macro
Department of Maxillofacial Surgery, S. Camillo Hospital,
Viale Somalia 289, 00199 Rome, Italy
Eur J Plast Surg (2005) 28: 343–353