Abstract
The “barn doors greenstick fracture” is a new concept that includes three contiguous
greenstick fractures: one in the central compartment of the nasal dorsum (nasal bones)
and two on the lateral walls of the bony nasal pyramid. The present study aimed to
describe this new concept and to report the first esthetical and functional outcomes.
This prospective, interventional, and longitudinal study was performed on 50 consecutive
patients undergoing primary rhinoplasty by spare roof technique B. The validated Portuguese
version of the Utrecht questionnaire (UQ) for outcome assessment in esthetic rhinoplasty
was utilized. Each patient answered the questionnaire online before surgery and 3
and 12 months after surgery. In addition, a visual analog scale (VAS) was used to
score nasal patency for both sides. The patients also answered three questions (yes
or no): (1) “Do you feel any step on your nasal dorsum?” if yes: (2) “Is that step
visible?” (3) “Does it bother you?”
A statistically significant improvement in UQ scores postsurgery was found, demonstrating
a high satisfaction index in this patient population. Additionally, the preoperative
and postoperative mean functional VAS scores showed a significant and consistent improvement
on both sides (right and left). Twelve months after surgery, a step at the nasal dorsum
was felt by 10% of the patients, but it was visible just in 4%, which were two females
with thin skin.
The barn doors greenstick concept provides a new approach to achieve a real and sustainable
smooth transition in the dorsal and lateral walls. The association of the two lateral
greensticks and the already described subdorsal osteotomy allows a real greenstick
segment in the most critical esthetic region of the bony vault—the root of the nasal
pyramid.
Keywords rhinoplasty - spare roof technique - preservation - osteotomies
