Crooked Nose Research Articles

Comparative Study between A unilateral and Bilateral Spreader Grafts with Collumellar Strut to Overcome C-shaped Crooked Nose

Comparative Study between A unilateral and Bilateral Spreader Grafts with Collumellar Strut to Overcome C-shaped Crooked Nose

Bony Dorsal Preservation.

Rhinoplasty is undergoing a transformation with the re-emergence of Dorsal Preservation Rhinoplasty (DPR) techniques. This article introduces a novel addition to the DPR repertoire, "Bony Dorsal Preservation" (BDP), which has particular application for the correction of crooked noses. In this comprehensive overview, we summarize current DPR concepts and techniques, the intricate considerations that go into the dorsal osseocartilaginous vault and septal management, and how these are modified to treat the crooked nose. However, current DPR techniques, particularly the Low Septal Strip (LSS), have drawbacks, and the desire to address such issues led to the development of BDP. BDP is ideal for cases where there is no septal base pathology. It maintains the core principle of DPR by lowering dorsal humps without creating open roof deformities. Its unique feature lies in the temporary separation of the upper lateral cartilages from the septum while leaving the septal base attachment intact, thus allowing the entire osseocartilaginous vault to be adjusted independently before reconnecting the preserved upper lateral cartilages. This technique offers direct visualization during septal excision and fixation and enables cartilaginous vault movement without sacrificing stability. Compared to LSS, there is more septal cartilage available for harvesting, the risks of a single point of septal fixation are eliminated, and there is the potential to transition to component reduction techniques if needed. With shared indications and contraindications with other DPR methods, BDP emerges as a valuable addition to the evolving field of rhinoplasty, particularly in addressing the challenges of the crooked nose.

Evaluation of Facial Asymmetry in Patients with Crooked Nose.

This study aims to explore the correlation between facial asymmetry and a crooked nose using objective methodologies. The cohort of 57 patients who underwent septorhinoplasty surgery for aesthetic reasons between 2019 and 2022. Patients were categorized based on the type of nasal axis deviation. The analysis involved reviewing patients' photographs and cone beam computed tomography images. We identified various anatomical landmarks and compared measurements across the groups. Among the study population, 21 (36.8%) exhibited Type-I (linear) and 15 (26.3%) demonstrated Type-C nasal axis deviation, while no deviation was detected in 21 (36.8%) patients. Upon evaluating the upper face area, significant differences were found in the glabella-lateral orbit (G-LO) and rhinion-lateral orbit (Rh-LO) parameters (p = 0.002 and p < 0.001, respectively). A statistically significant difference was discovered in all three parameters between the three groups in the middle face area [glabella-zygion (G-Zy) p = 0.04, rhinion-zygion (Rh-Zy) P < 0.001, anterior nasal spine-zygion (ANS-Zy) p < 0.001)]. Further, a statistically significant difference was noted in the soft tissue parameters gonion (Go) and LO (p = 0.008 and P = 0.005, respectively). Patients with crooked noses, in particular, exhibit asymmetries in the upper and middle faces. The glabella in the upper face and the anterior nasal spine in the middle face are stable points, and the fact that the parameters derived from these two reference points are significant, when considered in conjunction with other significant parameters, strongly supports the aforementioned statement. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Outcomes of Surgical Correction of Crooked Nose Deformity: An Objective Method of Assessment

Outcomes of Surgical Correction of Crooked Nose Deformity: An Objective Method of Assessment

Crooked Nose: Aesthetic and Functional Outcomes.

To highlight a detailed analysis of aesthetic and functional rhinoplasty outcomes utilizing the most recent highly validated Standardized Cosmesis Health Nasal Outcomes Survey (SCHNOS) for Middle Eastern crooked nose patients. A longitudinal cohort study scrutinizing preoperative rhinoplasty patients' satisfaction retrospectively and their postoperative outcomes prospectively. The patients fulfilled the Arabic SCHNOS during postoperative follow-up. Preoperative and postoperative responses were recorded and then reviewed and analyzed. This study included 41 patients with a mean age of 27.8 years. Females represented 41.5% of patients. About 73% of patients had a history of trauma. 90% of patients underwent primary procedures for crooked nose correction. Twelve patients (29.3%) underwent surgery for functional reasons, and twenty-six (63.4%) had it for both aesthetic and functional issues. There was a statistically significant difference regarding changes in SCHNOS regarding nasal obstruction scores (SCHNOS-O) and nasal cosmesis scores (SCHNOS-C) (p < 0.001). These findings coincided with a substantial reduction of all SCHNOS items postoperatively (p < 0.001). There was no statistically significant relationship between changes in (SCHNOS-O) or (SCHNOS-C) pre-and postoperatively and either age, sex, history of trauma, or type of surgery. However, a statistically significant difference was detected when assessing the relationship between changes in SCHNOS-O and the reason for surgery. A thorough knowledge of three-dimensional pathology and time-associated changes is required to achieve optimal aesthetic and functional outcomes for crooked nose patients. The use of highly validated questionnaires like SCHNOS in clinical practice is highly encouraged to modify and trace surgical techniques to the most appropriate and successful ones for the patients.

Nasal axis lateralization suture technique in crooked nose.

The aim of the present study was to objectively and subjectively compare the preoperative and postoperative aesthetic and functional outcomes of the correction of crooked noses using a suture technique we call "nasal axis lateralization suture (NALS)". A total of 36 patients who had preoperative and postoperative photographs taken and who completed the Rhinoplasty Outcome Evaluation (ROE) questionnaire were included in the study. Crooked noses were divided into two groups: C-shaped (17 patients) and I-shaped (19 patients). The preoperative and postoperative nasal axis angles were 145.3 ± 11.9 and 178.5 ± 3.3, respectively, in C-shaped nasal deviation. In I-shaped nasal deviation, on the other hand, the preoperative nasal axis angle was 8.8 ± 2.8, while the postoperative nasal axis angle was 1.4 ± 2.4. In terms of the ideal axis percentage before and after surgery, a significant difference was found between the C-shaped and I-shaped nasal deviation patient groups (p < 0.05). While there was a significant improvement in both groups in the evaluation based on the ROE questionnaire, satisfaction was much higher in the C-shaped nasal deviation group. In both groups, the ROE values of functional and aesthetic outcomes were significantly different compared to the preoperative values of both groups (p < 0.005). NALS can be used as an alternative technique to correct both I-shaped and C-shaped nasal axis deviations.

Use of Intraoperative Template for the Reconstruction of Septal Replacement Graft.

Anterior and caudal deviation of the septumcan severely affect a patient's functional and cosmetic outcomes, especially seen in crooked noses. Hence, extracorporeal septoplasty is often performed where an L-shaped septal replacement graft replaces the septum to restore the functionality and aesthetics of the nose. Although an L-shaped graft can be reconstructed with the help of a caliper, the exact length and angulation between the two cartilages cannot be accurately assessed intraoperatively and preoperatively and the graft needs repeated modification. In contrast, an L-shaped template can be easily made from a wrapper of suture material and can be customized to make the neoseptum. The cartilage graft can be exactly matched to the template, which can later be successfully used as a neoseptum. We have documented using the intraoperative template to make an accurate neoseptum in a crooked nose.Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Unilateral Fixation of the Bony Pyramid in Deviated Nose Correction.

Deviated nose correction is one of the most challenging procedures in rhinoplasty. Recent studies proposed effectiveness of preservation techniques even for patients with crooked nose deformity, although the long-term results are still controversial. Obviously, only addressing the blocking points is not enough to achieve stable midline position in crooked nose. To ensure consistent long-term results, we proposed a unilateral suturing of the bony pyramid along with unilateral resection of the excessive bone along the lateral osteotomy line. The first results of described surgical technique have proven its simplicity, reliability, and high efficiency both in primary and in revision surgeries. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluating the efficiency of endoscope-assisted septo-rhinoplasty via intranasal approach

Objective: To observe the functional and esthetic results of endoscope-assisted septo-rhinoplasty via intranasal approach. Methods: The clinical data of 12 patients with septal deviation and nasal deformity in the University of Hong Kong-Shenzhen Hospital from June 2021 to June 2022 were analyzed, including 8 males and 4 females, aging 28 to 58 years. All patients were operated under general anesthesia. The septal deviation was corrected by hemitransfixion incision, combined with intercartilaginous incision and other intranasal or extranasal incisions to perform osteotomy, hump resection and saddle nose correction. Patient satisfaction with postoperative functional and aesthetic improvements was assessed through Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcome Evaluation (ROE), and Visual Analogue Scale (VAS).SPSS 25 software was used for statistical analysis. Results: The correction of nasal septum deviation was satisfactory in all 12 patients. Nasal obstruction was relieved, with NOSE score and VAS score of nasal ventilation decreased [(21.67±10.30) vs (70.83±14.12), (1.83±1.03) vs (8.33±0.89), t value was 9.49 and 16.30, respectively, both P<0.05]. The nasal appearance of 10 patients with crooked nose deformity was improved, with ROE score and VAS score of nasal appearance increased [(21.30±2.31) vs (8.10±3.31), (8.90±0.99) vs (3.80±1.62), t value was -11.85 and -9.33, respectively, both P<0.05];The nasal vestibule morphology of 2 patients with abnormal nasal vestibule was improved. During the follow-up of 12 to 24 months, no postoperative complication such as nasal septum perforation, nasal cavity adhesion or nasal dorsal collapse occurred in all patients. Conclusion: Endoscope-assisted septo-rhinoplasty via intranasal approach can resolve both functional and esthetic problems at the same time, improving outcomes while reducing surgical trauma.

Double Lateral Osteotomy: Not Only the Correction of Crooked Noses but a Relevant Aesthetical Refinement in Structural Rhinoplasty.

Osteotomy represents a crucial step in structural rhinoplasty; however, there is not a unique approach accepted. Double lateral osteotomy has proven to be effective in the long-term correction of a deviated nose. In this series, we evaluated its aesthetic value also in non-deviated cases. 864 patients who underwent primary structural rhinoplasty from 2012 to 2020 were divided into four groups. Group A and B included patients with a crooked nose treated with asymmetrical double osteotomy and bilateral double osteotomy, respectively. Patients who did not present nasal deviation were divided into group C, including cases treated with bilateral single osteotomy, and group D, including patients who underwent bilateral double osteotomy. Postoperative evaluations were performed by three independent plastic surgeons blinded to the surgical technique. Patient's satisfaction was assessed through the FACE-Q rhinoplasty module. FACE-Q scores reported a satisfaction rate higher than 30% for every item in all groups; however, group B and group D showed statistically higher satisfaction (p < 0.01). According to the evaluations performed by physicians, group B and group D showed the most satisfactory outcomes (p < 0.01). bilateral double osteotomies represent a significant aesthetic refinement in structural rhinoplasty, not only in crooked noses but also in non-deviated cases, since the reduction in the width of the nose is an aesthetical aspect very appreciated by patients.

Lateral Crural Turn-Up Flap for Increasing the Volume of Cartilaginous Nasal Sidewall in Closed-Approach Dorsal Preservation Rhinoplasty.

Dorsal preservation rhinoplasty can also be applied in crooked nose cases. This article describes a lower lateral cartilage-based flap (lateral crural turn-up flap) used to correct cartilaginous nasal sidewall asymmetries. It was aimed to introduce a flap to be used in crooked nose cases operated with dorsal preservation rhinoplasty and to show possible modifications of this flap. Eight patients who had lateral crural turn-up flap due to crooked nose between July and December 2021 were included in this retrospective study. Standardized preoperative and postoperative 12-month front-view photographs were analyzed and scored for correction of midvault nasal sidewall asymmetries by 2 plastic surgeons. The Rhinoplasty Outcome Evaluation (ROE) scale was applied at 12 months. The mean score given by the surgeons for correction of midvault nasal sidewall asymmetries was 4.18. The mean ROE score was 89, and all patients were satisfied according to their ROE scores. There were no major complications. Unilateral lateral crural turn-up flap seems to be effective in correcting cartilaginous nasal sidewall asymmetries in crooked nose cases operated with dorsal preservation rhinoplasty.

The Use of a Unilateral Curved Spreader Graft in the Management of Crooked Nose Deformity.

The aim of this study is to present a new technique of using spreader grafts in the correction of crooked nose deformity with C-shaped deviation of the middle third of the nose. This is a prospective case series study conducted on 18 patients with crooked nose deformity with C-shaped deviation of the middle third of the nose. All of the patients were managed by open septorhinoplasty. During surgery, a curved spreader graft was harvested from the nasal septum and placed on the convex side of the C-shaped deviation of the dorsal part of the nasal septum. Objective measurements of the angles of external nasal deviation (END) and the internal nasal valve (INV) angles were performed before and 6 months after the surgery. Subjective assessment of aesthetic satisfaction by the visual analog scale and nasal function by the nasal obstruction symptom evaluation scale was also performed before and 6 months after surgery. Eighteen patients were enrolled in the study and completed the minimum follow-up period of 6 months. The mean follow-up period was 17.3 months. Objectively, there was highly significant ( P < 0.00001) improvement of the END angle and INV angle. Subjectively, there was also highly significant ( P < 0.00001) improvement of both the nasal obstruction symptom evaluation score and the visual analog scale score for aesthetic satisfaction. The insertion of a curved unilateral spreader graft over the convexity of the deviated nasal dorsum can correct the END, improve the collapsed INV on both sides, and consequently achieve satisfactory aesthetic and functional outcomes.

Applied surgical methods and outcomes in crooked nose rhinoplasty.

In this retrospective and multicentric study, we investigated applied surgical methods in rhinoplasty for crooked nose deformity. The retrospective data for 300 crooked nose deformity cases (191 males and 109 females) were used in our study. Classification of the initial deformities was performed as (1) I-shaped crooked nose deformity, (2) C-shaped crooked nose deformity, (3) Reverse C-shaped crooked nose deformity, and (4) S-shaped crooked nose deformity. As an operation technique, L-strut septoplasty was performed. The applied surgical methods in rhinoplasty to correct the crooked nose are evaluated and classified. Our results showed that initial deformities in crooked nose patients were I-shaped crooked nose deformity (34%), C-shaped crooked nose deformity (28%), Reverse C-shaped crooked nose deformity (21.3%), and S-shaped crooked nose deformity (16.7%). L-strut septoplasty was performed, and the results of the applied methods to correct the crooked nose were evaluated and classified. It was noticed that more than one procedure was applied to each case: (1) double-side lateral osteotomy (86.6%), (2) wedge bone resection on one side of the osteotomy (7.3%), (3) single-side lateral osteotomy (6%), (4) symmetric spreader grafts (56%), (5) asymmetric spreader grafts (10.6%), (6) shaving of the transverse wing of dorsal septum (8%), (7) correction of deviated dorsal septum (16.3%), (8) displaced anterior nasal spine (12.6%), (9) clocking suture (dorsal septal rotation suture) (9%), (10) dorsal septal scoring and splinting graft (8.3%), and equalizing lateral cruses (12.6%). I-shaped and C-shaped crooked nose deformities were mainly detected in crooked nose deformity patients. Correcting the crooked nose, double-side lateral osteotomy, and symmetric spreader grafts were the most applied techniques to correct the crooked nose. Other rhinoplasty techniques were also applied to these patients; more than one technique was needed.

Efficiency of Middle Vault Reconstruction with Dorsal Septal T Flap in Achieving Ideal Dorsal Aesthetic Lines and Regularity.

Dorsal aesthetic lines and irregularities are the most critical points that can be manipulated in rhinoplasty operations. Although spreader grafts and flaps have been used for this purpose in the reconstruction of the keystone area for a long time, dorsal irregularity is often inevitable. This study aims to evaluate the effectiveness of dorsal septal T flap and nasal dorsum reconstruction in achieving ideal dorsal aesthetic lines and regularity. Thirty-four patients (30 women, 4 men) who underwent closed technique rhinoplasty between 2019 and 2021 were included in the study. The mean age of the patients was 25.4 years. Patients with crooked nose, severe deviation, and severe dorsal hump were also excluded. All patients included in the study underwent Rhinoplasty Outcome Evaluation (ROE) questionnaires preoperative and postoperative 1st year. The mean age of the patients was 25.4 years (range 18-40years). A total of 34 patients, including 30 women and four men, were operated. The mean follow-up period was 13.2 months, ranging from 12 to 14months. In the physical examinations performed at the control visits, no functional problem was encountered in any patients. Preoperative and postoperative mean ROE scores were 60.9 and 92.7, respectively. With the technique described in the study, dorsal hump recurrence is minimized compared to other preservation techniques. Since the keystone area transition can be fine-tuned, continuity is ensured, and ideal dorsal aesthetic lines are created. The stability of the upper lateral cartilages is provided, thus eliminating the need for spreader grafts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Management of Posttraumatic Nasal Deformities.

Nasal bone fractures are the most common fractures of the facial skeleton and are often accompanied by bony, cartilaginous, and soft tissue injuries. These injuries are often complex, and when untreated or inadequately treated, can lead to posttraumatic nasal deformity. The most common deformities are the crooked nose and the saddle nose. Both deformities may result in significant cosmetic and functional concerns. The treatment of these deformities can be complex, requiring careful evaluation of the nose and thoughtful planning to correct the cosmetic deformity and restore functional integrity. The rhinoplasty surgeon will benefit from having a large repertoire of techniques to achieve these repairs. In this article, we discuss the options and concepts for the management of nasal bone fractures as well as complicated posttraumatic nasal deformity. Level of evidence is not available.

The Morphological and Functional Effects of the Endoscope-Assisted One-Stage Approach for Crooked Nose.

A crooked nose is an external nose deformity predominantly caused by congenital aplasia or acquired secondary to trauma or surgery, often accompanied by a deviated nasal septum. Patients with crooked nose have dual needs to improve both esthetic and functional problems. The clinical and photographic information of 48 patients diagnosed with a crooked nose and nasal septum deviation treated from January 2018 to January 2022 was acquired. The morphology and functional effects were investigated by evaluating the general condition of the operation, measuring the esthetic indexes of the nose, and subjectively scoring. For both morphology and function, endoscopy-assisted one-stage correction showed positive results in this study. The external nose deviation distance postoperatively measured 1.28 (0.85, 1.97) mm, which significantly decreased from the preoperative value of 3.96 (3.31, 5.29) mm. The scores of doctors and irrelevant medical students on nose morphology increased significantly from 4.75±1.88 and 3.84±0.76 to 6.48±1.21 and 7.21±0.67, respectively. The rhinoplasty outcome evaluation score and the "nasal obstruction symptom evaluation "score of patients were both significantly improved ( t = -7.508 and t =6.310, respectively, P < 0.001). Endoscope-assisted one-stage correction of the crooked nose can restore nasal morphology, improve the symptoms of nasal obstruction, and achieve patient satisfaction. It is a minimally invasive, safe, effective, and fast recovery approach for patients who need to solve both esthetic and functional problems.

Partial Extracorporeal Septoplasty in Crooked Noses.

In crooked noses, the standard septoplasty is a challenge because of the complex deviation of the septum, where straightening of the cartilage in situ is impossible. Hence, it is required to remove the partial/total septum and later is replaced backafter being straightened; the procedure is called partial/total extracorporeal septoplasty. In the present study, we shared our experience of partialextracorporeal septoplasty in patients with crooked noses. It is a retrospective analysis of 30 crooked noses who underwentextracorporeal septoplasty due to gross septal deviation from March 2020 to August 2022. The functional and aesthetic outcomes were evaluated at the end of 12 months. Of 30 cases, partial and totalextracorporeal septoplasty was performed in 28 casesand twocases respectively. Neoseptum was reconstructed with septal cartilage in 27 (90%) cases, costal cartilage in one case and conchal cartilage was usedin two instances. All the patients had good functional and aesthetic outcomes till 12 months of follow-up, and there were no major intraoperative or postoperative complications. Extracorporeal septoplasty can be an excellent surgical procedure in the highly deviated nasal septum, in Indian noses with a crooked nasaldeformity. It provides adequate exposure to the whole septum, ensuring good functional and aesthetic outcomes with minimal complication rate. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Functional and Aesthetic Outcomes of Asymmetric Dorsal Preservation for Correction of I-Shaped Crooked Nose Deformity.

The study was designed to evaluate the effectiveness of the asymmetric dorsal preservation technique for correcting I-shaped crooked nose deformity (CND). Patients with I-shaped CND who underwent asymmetric dorsal preservation in the period from September 2020 to September 2021 were included in this retrospective study. The Rhinomanometry and Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) was used to assess the outcomes. Deviation angle (DA) measurements were used to evaluate the degree of crookedness. The results were recorded both preoperatively and 12 months postoperatively. Twenty-three patients were included in the study. Total nasal airflow and long-side nasal airflow were significantly higher 12 months postoperatively (p=0.001 each). Total nasal resistance, long-side nasal resistance, SCHNOS scores and DA measurements were significantly lower 12 months postoperatively (p<0.001 each). Asymmetric dorsal preservation is a successful alternative technique for correcting I-shaped CND and achieving optimal aesthetic and functional outcomes.

Septal Reconstruction: Simple to Complex.

Nasal septal deviation is a frequent problem treated by otolaryngologists and facial plastic surgeons. Complete correction of the septal deformity is often essential both for straightening a crooked nose and for restoration of the nasal airway. While standard septoplasty techniques provide excellent outcomes in most patients, severe septal deformities may require treatment with more advanced maneuvers including adjacent grafting, caudal septal replacement, and even extracorporeal septoplasty. This article reviews a range of septoplasty techniques, with an emphasis on complex septal reconstruction and approaches that can be utilized to maintain keystone stability and establish a robust midline L-strut even in cases with challenging anatomy.

Two Cases of Unilateral Osteotomies for Traumatic Severely Deviated Noses

A severely deviated nose accompanied with trauma is difficult to correct, but osteotomy, a common surgical technique, can correct such deviation. This study aims to evaluate the usefulness of unilateral osteotomy, a technique for correcting a severely deviated nose driven by trauma. Two patients, both with deviated nose caused by trauma but one with a C-shaped nose and another with a reverse C-shaped nose, underwent surgery. Cartilage and bone humps were removed by a knife and a rubin osteotome, respectively. Unilateral osteotomy was performed on the convex area to correct the crooked nose and camouflage dorsal graft was used to treat the lowered dorsum. No postoperative complications were reported during the follow-up periods. Both patients were satisfied with the outcomes. This paper presents successful cases of unilateral osteotomy and suggests this treatment as an effective way of correcting deviated nose caused by trauma.