Does narrowing the nasal bridge with osteotomy reduce nasal airway width? Examining the impact on nasal airflow in research

Osteotomy of the nasal bone has been reported as a method to narrow the width of the nasal bridge, but there are not many studies that have measured how many millimeters the narrowing is[1]. The clearer numerical data actually come from the nasal airway itself, where it has been reported that the cross-sectional area for air passage becomes an average of 25.96% smaller after osteotomy[2]. The aesthetic width and nasal airflow are two sides of the same operation, so both need to be considered together[3].

By how many millimeters does the width narrow?

No reports showing millimeter measurements have been found. Reports on lateral osteotomy with less burden for wide noses contain only descriptions stating that the nasal bridge narrows and the technique is easier to perform, without indicating the amount of width change.[1].

Therefore, to the question "How many millimeters will it become narrower?", the only answer you will receive is an estimate based on experience. It is more concrete to look at photographs or simulations and confirm which part of the width will be changed and which bone will be moved.

How much does bone thickness vary between individuals?

Measurement shows differences by sex. In a study measuring bone thickness at the osteotomy line on preoperative CT, females showed right 1.54±0.25 mm and left 1.54±0.28 mm, while males showed right 1.66±0.28 mm and left 1.67±0.30 mm, with a statistically significant difference (p<0.05)[4].

On average, the bone thickness at the osteotomy line is approximately 1.54 mm in females and approximately 1.66 mm in males.[4]When thickness differs, how the bone breaks and splits changes as well. This study positions preoperative imaging evaluation as useful for planning the osteotomy method and the amount of force.[4]Whether or not to obtain preoperative CT imaging is one item you should confirm.

Does the nasal airway become narrower?

Yes, it does narrow. Textbooks explain that lateral osteotomy brings the nasal bone and upper lateral cartilage medially, thereby narrowing the airway.[3]The degree of reduction has been reported as an average of 19.71% in people with short nasal bones and 26.23% in those with long nasal bones.[2].

The range is quite large, with 0% to 67% across the population as a whole, averaging 25.96%.[2]In other words, some people show almost no change, while others experience more than 50% narrowing. The more you already have nasal congestion, the more value there is in discussing this point in advance.

Are there measures to preserve the airway?

There is a method of placing a cartilage graft along the inside of the nasal bridge. Textbooks indicate that this cartilage graft is indicated for the purpose of preventing functional deterioration and inverted-V deformity, where the nasal bridge appears pinched when viewed from the side.[3].

It is also explained that people with longer nasal bones experience greater airway reduction.[3]Whether your nasal bone is long or short can be determined from imaging. The decision to add support along with width reduction is not made from aesthetic preference alone, but depends on baseline airflow ease.

How is change in facial appearance measured?

There are reports measuring this by angles. In a review of surgery to bring facial features closer to feminine appearance, in 12 cases undergoing osteotomy, the nasal-forehead angle at 1 year postoperatively increased from 141.6±6.0 degrees to 150.5±5.5 degrees, and the nasal-labial angle increased from 107.4±14.3 degrees to 115.2±11.7 degrees (both p<0.001)[5].

However, this is in the context of surgery with a different purpose, and involves only 12 cases, a small sample.[5]Patients who underwent width reduction alone may not experience the same angle changes. Use the numbers only as a reference for direction, and confirm how you will look in your own face by photograph.

Four things to confirm at consultation

The first is whether you want to narrow the bony portion or the cartilage portion below it.[1]The second is whether you will examine bone length and thickness on preoperative imaging.[4]The third is the current degree of nasal congestion and how it might change after osteotomy.[2]The fourth is whether a cartilage graft will be added to preserve the airway.[3].

Nasal width is determined not only by bone shape, but also by skin thickness and the protrusion of the lateral nasal walls. From an article alone, you cannot determine which part of your own nose the osteotomy will affect. At consultation, after confirming nasal bone length and thickness and your current nasal airflow, please work with your surgeon to clarify which to prioritize — width or function — and to what extent.