Deviated Nose: A Systematic Approach for Correction

Abstract

Attaining a straight dorsum in patients with deviated nose is a main task in rhinoplasty. The basis of this difficulty is the presence of multiple anatomical abnormalities; hence, many methods are used to correct such a deformity. In this study, a sequential comprehensive surgical approach is proposed for the correction of deviated nose.

Methods: Seventy-six patients who presented with developmental or posttraumatic external nasal deviation were enrolled in this study. All patients were subjected to open septorhinoplasty using a systematic approach. The outcome was assessed throughout for patient satisfaction.

Results: The postoperative course was uneventful. Minor complications were encountered as transient hypoesthesia in the nasal tip in 4 patients and as prolonged tip edema in 10 patients. Residual significant nasal deviation was observed in 3 patients, and only 1 of them necessitated revision. All patients reported improvement of their nasal airway, and the percentages of their aesthetic satisfaction were as follows: very satisfied (n = 57, 75%), satisfied (n = 18, 23.7%), and unsatisfied (n = 1, 1.3%).

Conclusions: A simple and comprehensive approach for correction of deviated nose is presented, which resulted in a better long-term cosmetic and functional outcome. This approach could correct the deviations in various anatomic locations, and helps the surgeon to deal with nasal deviation in an effective and straightforward manner wherever the pathology of deviation.

Fig. 1.

Schematic diagram of the comprehensive approach used for correction of deviated nose. A, Exposure through marginal and stair-step incisions. B, Caudal, central, and cephalic septoplasty. C, Medial and lateral osteotomies. D, Scoring of the dorsal and caudal L-strut. E, Grafting in the form of spreader. F, Columellar strut.

Fig. 2.

Caudal septoplasty involves disengaging the septum from the maxillary crest, excision of overhanging part of cartilaginous septum and a wedge from the posterior aspect, and release of tension in the cartilage to allow it to swing back to the midline. A, Marking of the overhanging caudal and posterior parts of the septum. B, The excised parts.

Fig. 3.

Central septoplasty involves resection of an appropriate amount of the deflected cartilage (A), and osseocartilaginous junction between quadrangular cartilage and perpendicular plate of ethmoid bone (B).

Fig. 4.

A and B, Preoperative views of a patient with posttraumatic right nasal deviation. C and D, Postoperative views of the patient’s face after 1 year, showing consistent satisfactory results.

Fig. 5.

A and B, Preoperative views of a patient with recurrent left nasal deviation. C and D, Postoperative views of the patient after 6 months, showing pleasing results.