Methods of Lateral Osteotomy in Rhinoplasty: An Updated Systematic Review and Meta-Analysis of Randomised Controlled Trials.

[OBJECTIVE] To provide an up-to-date systematic review and meta-analysis of randomised controlled trials (RCTs) evaluating the postoperative outcomes of two lateral osteotomy techniques (external vs. internal) in patients undergoing rhinoplasty.

[METHODS] We conducted a comprehensive search in PubMed, Scopus, Web of Science, Embase, and the CENTRAL from their inception until January 2025. Eligible RCTs were assessed for risk of bias using Cochrane's risk of bias tool. The specific outcomes included clinically relevant measures, such as eyelid edema, ecchymosis, and step-off deformity. Standardised mean differences (SMD) and risk ratios (RR) with 95% confidence intervals (CIs) were used to combine the data. STATA software was used for statistical analysis.

[RESULTS] A total of 13 RCTs involving 1008 patients were included. Five RCTs demonstrated a low risk of bias, six had some concerns, and two exhibited a high risk of bias. The pooled analysis showed no significant difference in eyelid edema between the external and internal osteotomy groups at 2 days (SMD = -0.13, 95% CI [-0.49, 0.22]), 3 days (SMD = -0.14, 95% CI [-0.77, 0.48]), and 7 days (SMD = -0.08, 95% CI [-0.27, 0.12]). Similarly, no significant difference was observed in ecchymosis between the two groups at 2 days (SMD = -0.12, 95% CI [-0.51, 0.27]), 3 days (SMD = -0.21, 95% CI [-1.11, 0.70]), and 7 days (SMD = -0.10, 95% CI [-0.33, 0.12]). The mean score of step-off deformity was significantly higher in the external osteotomy group compared to the internal osteotomy group (SMD = 0.54, 95% CI [0.19, 0.89]), whereas the rate of step-off deformity did not differ significantly between the groups (RR = 0.79, 95% CI [0.43, 1.44]).

[CONCLUSION] This updated systematic review and meta-analysis of 13 RCTs involving 1008 patients demonstrated comparable outcomes between external and internal lateral osteotomy in terms of postoperative eyelid edema, ecchymosis, and step-off deformity in patients undergoing rhinoplasty.

[TRIAL REGISTRATION] PROSPERO: CRD420251003922.