Septal Surgery in the Crooked Nose

Abstract

The deviated nose represents a complex cosmetic and functional problem. Septal surgery plays a pivotal role in the successful management of the externally deviated nose, as adequate realignment of the external bony cartilaginous framework is almost impossible to achieve in the presence of a deviated septum. The commonest septal deviations, to affect nasal symmetry, are those involving the dorsal and caudal segments of the cartilaginous septum. As compared to central septal deviations, which can be safely excised without affecting the shape of the nose, any excisions involving the dorsal or caudal septum will directly affect the shape of the external nose due to weakening of dorsal and/or tip support. A graduated surgical approach was adopted to allow correction of the dorsal and caudal deviations of the nasal septum without weakening its structural support to the nasal dorsum or nasal tip. The approach depends on full mobilization of deviated cartilage, followed by straightening of the cartilage and its fixation in the corrected position by using bony splinting grafts through an external rhinoplasty approach.