The crooked nose is one of the most challenging problems in rhinoplasty surgery and is the most severe form of a deviated nose. While every crooked nose is different to some degree, they all have anatomic deformities of the nasal bones, the upper and lower alar cartilages and the nasal septum. One distinguishing feature of the crooked nose is the deviation of the nasal pyramid or nasal bones. These nasal pyramid deformities have been classified as I, C, reverse C and S-shaped.
In the February 2016 issue of the Aesthetic Surgery Journal an article appeared entitled ‘A Combined Approach to the Crooked Nose’. In 22 crooked nose patients, nasal osteotomies were performed with the creation of an asymmetric medial oblique osteotomy and double lateral osteotomies. The concept is that the asymmetric nasal bone where it joined with the maxillary bone is fractured and inwardly relocated. A septoplasty is then performed with L-strut conservation. The L-strut was removed as a 1 cm segment from the septal stump at the keystone area. A batten septal graft is placed on the concase side of the deviation. The L-strut is then replaced and sutured on the batten graft to redirect the septum to the midline. Finally, an overlapping cruroplasty is done on teh side of the asymmetric lower alar cartilage to help correct the tip deviation.
The authors report that their crooked nose technique was effective for each patient treated. They conclude that the K-stone batten plasty with delivery to the face and overlapping cruroplasty at the tip is an effective rhinoplasty method for the crooked nose deformity.
The crooked nose is challenging and this paper essentially describes an extracorporeal septoplasty technique with asymmetric nasal osteotomies. Such ‘aggressive’ rhinoplasty techniques are often needed when the differences in the two sides of the nasal bones and cartilage are discrepant in both size and positioning. Even such septorhinoplasty approaches still do not always make for a perfectly straight nose.
Dr. Barry Eppley
Indianapolis, Indiana