Lateral Rhinotomy

Lateral rhinotomy is a surgical procedure not used often enough for evaluation, diagnosis and removal of intranasal neoplasms.  The Lateral Rhinotomy approach is designated for access for tumors involving the nasal cavity ethmoid sinus or frontal skull base. This allows exposure of the entire nasal cavity. Superiorly, this extends to the skull base and inferiorly to the floor of the nose. All three turbinates are also visible.

Preparation

The patient is placed in a horizontal position with the whole face prepared and draped into the surgical field.

Insertion of tarsorrhaphy suture

A 6.0 suture is inserted through the skin of the upper eyelid and exits through the Gray line of the upper lid margin.

In the lower eyelid the needle is inserted from the Gray line into the skin where it exits.

The suture is directed back, picking up the same soft-tissue portions in the lower and upper eyelid to complete the mattress loop.

The tarsorrhaphy is not firmly secured and some space is left between the knot and the upper-eyelid skin. A hemostatic clamp is used to grasp the suture and apply traction to lower lid for full eyelid closure during the surgery.

Since the suture was not tightened completely, when the hemostatic clamp is released, the lid may be opened for a forced duction test or evaluation of the pupil during the surgical procedure.

Soft tissue incision

The tissue is infiltrated with local anaesthetic containing vasoconstrictor.

The incision is made around the base of the nose and along the facial nasal groove. The dissection goes deep to the subperiosteal plane of the frontal process of the maxilla. Below the nasal bone the incision is deepened through the nasal mucosa.

Osteotomy

The lateral aspect of the nasal bone is identified. A one-sided nasomaxillary osteotomy is made with a small osteotome, and the 2 osteotomy lines are merged at the level of the naso frontal junction.

The soft tissue and nasal skeleton are elevated and reflected to the contralateral side. This allows the exposure of the nasal cavity. The septum is cut and freed from the mobilized segment according to the resection plan.

This cut is usually part of the tumor resection.

Closure

The nasal skeleton is rotated back in place and no fixation is needed, though a microplate fixation of the nasal bones may be used. The subcutaneous tissues are closed with an absorbable suture and the skin is closed with a permanent suture.

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