Histopathological comparison of bone healing effects of endonasal and percutaneous lateral osteotomy methods in rabbit rhinoplasty model

Abstract Introduction: Lateral osteotomy is mainly performed either endonasally or percutaneously in rhinoplasty which is a frequently performed operation for the correction of nasal deformities. Both techniques have both advantages and disadvantages relative to each other. Objective: The aim of this study was to compare the histopathological effects of endonasal and percutaneous osteotomy techniques performed in rhinoplasty on bone healing and nasal stability in an experimental animal model. Methods: Eight one year-old New Zealand white rabbits were included. Xylazine hydrocloride and intramuscular ketamine anesthesia were administered to the rabbits. Endonasal osteotomy (8 bones) was performed in Group 1 (n = 4), and percutaneous osteotomy (8 bones) in Group 2 (n = 4). One month later the rabbits were sacrificed. Bone healing of the rabbits was staged according to the bone healing score of Huddleston et al. In both groups, nasal bone integrity was assessed subjectively. Results: In the percutaneous osteotomy group, Grade 1 bone healing was observed in two samples (25%), Grade 2 bone healing in two samples (25%), Grade 3 bone healing in four samples (50%). In the endonasal osteotomy group, Grade 1 bone healing was observed in 6 samples (75%) and Grade 2 bone healing was observed in 2 samples (25%). In the percutaneous group, fibrous tissue was observed in 2, predominantly fibrous tissue and a lesser amount of cartilage was observed in 2 and an equal amount of fibrous tissue and cartilage was observed in 4 samples. In the endonasal group, fibrous tissue was observed in 6 samples, and predominantly fibrous tissue with a lesser amount of cartilage was observed in 2 samples. In both groups, when manual force was applied to the nasal bones, subjectively the same resistance was observed. Conclusion: Percutaneous lateral osteotomy technique was found to result in less bone and periost trauma and better bone healing compared to the endonasal osteotomy technique.

摘要 引言：鼻成形术是矫正鼻部畸形的常用手术，其中侧方截骨术主要经鼻内入路或经皮入路开展，两种术式各有优劣。研究目的：本研究旨在通过实验动物模型，对比鼻成形术中经鼻内与经皮侧方截骨术对骨愈合及鼻部稳定性的组织病理学影响。方法：纳入8只1岁龄新西兰白兔，对家兔肌注盐酸赛拉嗪与氯胺酮实施麻醉。第1组（n=4）实施经鼻内截骨术（共8处骨截骨），第2组（n=4）实施经皮截骨术（共8处骨截骨）。术后1个月处死家兔，参照赫德尔斯顿等（Huddleston et al.）提出的骨愈合评分标准对家兔的骨愈合情况进行分期，并对两组家兔的鼻骨完整性进行主观评估。结果：经皮截骨术组中，2例样本（25%）表现为1级骨愈合，2例（25%）为2级骨愈合，4例（50%）为3级骨愈合；经鼻内截骨术组中，6例样本（75%）表现为1级骨愈合，2例（25%）为2级骨愈合。经皮组中，2例样本可见纤维组织，2例以纤维组织为主且伴少量软骨，4例样本纤维组织与软骨含量相当；经鼻内组中，6例样本可见纤维组织，2例以纤维组织为主且伴少量软骨。对两组家兔鼻骨施加手动外力时，主观检测到的阻力无明显差异。结论：相较于经鼻内侧方截骨术，经皮侧方截骨术对骨及骨膜的创伤更小，骨愈合效果更优。