SELF: A Novel Algorithm for Deciding the Position of Lateral Osteotomies in Rhinoplasty Patients with Minimal External Deviation.

[BACKGROUND] Although the different techniques and instruments described for lateral osteotomies date back decades, the literature on deciding the position of lateral osteotomies between the sides is limited. In general, the position of lateral osteotomies is decided by frontal view and palpation, but this is not always easy, especially in minimally deviated noses.

[METHODS] The SELF algorithm, which includes 4 developmentally related parameters, was used to decide the position and number of lateral osteotomies. Parameters of the SELF algorithm are septal position in nasal floor, external alar length, lateral pyramidal length and frontal pyramidal deviation's starting side. After considering and evaluating these parameters, either double lateral or high lateral osteotomy was performed on the side where the bony wall was considered to be longer.

[RESULTS] Out of 521 patients whose lateral osteotomy level was decided by applying the SELF algorithm, 493 were female, and 28 were male. The ages of the patients ranged from 18 to 59 years. Based on the SELF algorithm, 401 double lateral and 85 high lateral osteotomies were performed on the side with the longest anterior-posterior distance of the bony pyramid. No serious complications, either functionally or aesthetically, were encountered related to lateral osteotomies performed based on the SELF algorithm.

[CONCLUSIONS] There is a relationship between the position of the septum at the nasal floor, external alar length, lateral pyramidal projection and frontal deviation, as the tissues in the nose are shaped in relation to each other during development. The SELF algorithm based on these parameters can provide assistance to the surgeon in terms of selecting the position and number of lateral osteotomies, especially in minimally deviated noses.

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