• Archives of Plastic Surgery
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• v.47 no.6
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• pp.505-515
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• 2020

Deviated nose is highly challenging in rhinoplasty since the surgeon should consider both aesthetic and functional aspects of the nose. Deviated nose correction is surgically complex, and a thorough understanding of the mechanical and physiological changes of intranasal structures, including the septum and turbinates, is necessary for functional improvement.

• Archives of Craniofacial Surgery
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• v.19 no.2
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• pp.85-93
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• 2018

Deviated nose deformities have always been a surgical challenge, and it is essential to achieve both functional and esthetic improvements. Various techniques have evolved over time to correct deviated noses but no one method applies in all cases. Successful correction requires a complete understanding of the various surgical techniques and concepts, including the three-dimensional nasal structure and the time-related changes to surgically-treated noses.

• Archives of Plastic Surgery
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• v.47 no.6
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• pp.495-504
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• 2020

The primary procedural components of deviated nose correction are as follows: osteotomy to correct bony deviation, septal deviation correction, manipulation of the dorsal septum to correct upper lateral cartilage deviation, and correction of functional problems (manipulation for correction of internal valve collapse and hypertrophy of the inferior turbinate). The correction of tip and nostril asymmetry cannot be overemphasized, because if tip and nostril asymmetry is not corrected, patients are unlikely to provide favorable evaluations from an aesthetic standpoint. Tip asymmetry, deviated columella, and resulting nostril asymmetry are primarily caused by lower lateral cartilage problems, which include deviation of the medial crura, discrepancy in the height of the medial crura, and asymmetry or deformity of the lateral crura. However, caudal and dorsal septal deviation, which is a more important etiology, should also be corrected. A columellar strut graft, correction of any discrepancy in the height of the medial crura, or lateral crural correction is needed to correct lower lateral cartilage deformation depending on the type. In order to correct caudal septal deviation, caudal septal shortening, repositioning, or the cut-and-suture technique are used. Surgery to correct dorsal septal deviation is performed by combining a scoring and splinting graft, a spreader graft, and/or the clocking suture technique. Moreover, when correcting a deviated nose, correction of asymmetry of the alar rim and alar base should not be overlooked to achieve tip and nostril symmetry.

• Archives of Plastic Surgery
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• v.47 no.6
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• pp.516-521
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• 2020

In rhinoplasty, osteotomy is becoming more and more frequent as a way to achieve aesthetically pleasing and functional results, as well as patient satisfaction. In procedures to correct a deviated nose, osteotomy to correct the bone plays an essential role in addition to correction of the septum and cartilage, and osteotomy can reduce the wide nose bridge and give a slightly higher appearance in Asian rhinoplasty. However, osteotomy is relatively invasive, and the nasal bones of Asians are often low and thick, so bleeding or swelling during surgery can be somewhat more severe, and a stuffy nose can occur after surgery if osteotomy is performed incorrectly. Since side effects are possible, it is necessary to have a precise understanding of the relevant anatomy and technique. Several articles have described nasal bone osteotomy in rhinoplasty, and this review article introduces the methods presented in various articles, describes indications and limitations, and reviews the relevant anatomical structures and techniques in an accurate manner. We introduce a method that can increase patients' satisfaction and the completeness of surgery through accurate osteotomy, as well as reducing the risk of side effects.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.4
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• pp.266-270
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• 2009

The osteotomy for rhinoplasty is a useful method to make the nasal bony pyramid get narrow, correct the deviated nose and prevent the open roof deformity after hump nose resection. The osteotomy for rhinoplasty is divided medial osteotomy, lateral osteotomy and transverse osteotomy. If the osteotomy is well done, it produces very effective and esthetic results. However, the osteotomy has problems that precise operation is often impossible for the difficulty of the access and that the possibility of the complication is very high. We report our clinical experience about the osteotomy for rhinoplasty.

• Archives of Plastic Surgery
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• v.32 no.1
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• pp.37-42
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• 2005

The human nose is located in the center of the face and it's cosmetic importance is high. The contour of the nasal dorsum and side walls play a major role in the shaping of the nose, and even a slight distortion may results in significant variance of the human facies. However, in the case of patients with wide nasal bone, augmention rhinoplasty can make nasal planes look wide, resulting in bulbous appearing noses or lateral borders of the nasal implant may be visible after the surgery making the final cosmetic results unsatisfactory. To solve such problems, from march, 1999 to march, 2004, the authors have performed augmention rhinoplasty in 36 patients. The cause of operations were as follows: flat nose 20, hump nose 5, deviated nose 4, secondary rhinoplasty 7. Paramedian osteotomy was performed at a distance that was the same as the width of the implant from the midline(5 mm + 5 mm). To prevent it from connecting to the roof at the lateral osteotomy line, intentional green stick fracture of the roof was performed. Agumentation rhinoplasty was done with either Silicone or Gortex and ear cartilage as a supplement. The follow up period was 2 weeks to 13 months with an average of 5.5 months. There were no infections and postoperative bleeding. As a result, the nose was augmented higher and narrower than before which we and the patient both found highly satisfactory.

• Archives of Plastic Surgery
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• v.32 no.6
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• pp.710-716
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• 2005

A total of 21 patients were operated. Via a columellar labial incision, the upper lateral cartilages were separated from the septum. A submucous resection of the septal cartilage was carried out. After rasping the convex lateral nasal wall of the unaffected side, a low-to-low lateral nasal osteotomy was conducted. Along the deviated dorsal line at the bony vault passing the submucous tunnel, a paramedian nasal osteotomy was performed. The convex side of the nasal bone flap was contoured by rasping. The convex side of the "T"-shaped dorsal septum was trimmed. A total direct septal extension graft of the septal cartilage was done and the alar cartilages were suspended to it. The postoperative results were evaluated by photogrammetric analysis processed by a "neon glow" filter in Adobe Photoshop. The distance from the nasal midline to the most deflective point at 5 levels was measured, and the proportion indices were obtained in regard to intercanthal distance. The results revealed improvement in all levels (p < 0.05), although not perfect. In summary, this technique can result in a clinically good-looking in spite of a slight deflection that still exists

• Archives of Plastic Surgery
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• v.34 no.2
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• pp.243-249
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• 2007

Purpose: Posttraumatic nasal deformities might not be corrected adequately by conventional osteotomy techniques when the configuration of the nasal bone has been changed due to malunion. To consistently obtain good aesthetic and functional results, the anatomic reduction of malunion sites of the nasal bone is important. The purpose of this study is to present an osteotomy technique, including refracture along malunion sites and anatomical reduction of a malformed nasal bone, for the correction of a posttraumatic deviated nose. Methods: From March of 2003 to May of 2004, 27 patients, who underwent corrective rhinoplasty for the correction of bony pyramid deviation, were included in this study. Postoperative results of the technique were evaluated objectively at 1 year after surgery regarding nasal midline location, nose symmetry, and nasal contour. Results were rated as excellent, good, fair, or poor. All patients were also evaluated subjectively for cosmetic improvement, changes in breathing, and overall satisfaction. Results: Objective analysis of the outcomes revealed an excellent result in 17 patients(63%), good in 9(33%), and fair in 1 patient(4%). No case evaluated had a poor result. Regarding subjective analysis, 19 patients(70%) evaluated the cosmetic outcome as perfect. Among the 21 patients with preoperative airway problems, 19 patients(90%) reported improved breathing post-operatively. Patients' overall satisfaction levels were also very positive. No postoperative complications occurred during the 14 month mean follow-up period. Conclusion: The osteotomy technique presented in this study is simple, effective, and safe for correcting posttraumatic nasal deviation, and also produces consistent results.

• Clinical and Experimental Otorhinolaryngology
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• v.11 no.4
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• pp.288-292
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• 2018

Objectives. To investigate the common causes of persistent septal deviation in revision septoplasty and to report the surgical techniques and results to correct them. Methods. A total of 100 consecutive patients (86 males) who had revision septoplasty due to persistent septal deviation from 2008 and 2014 were included in the study. Their mean age was 35.6 years and the mean follow-up duration was 9.1 months. Presenting symptoms, sites of persistent septal deviation, techniques used to correct the deviation, and surgical results were reviewed. Results. The mean interval between primary and revision surgery was 6.2 years. Forty-eight patients received revision septoplasty and 52 received revision septoplasty combined with rhinoplasty. Nasal obstruction was the most presenting symptom in almost all patients. The most common site of persistent septal deviation was middle septum (58%) followed by caudal septum (31%). Correcting techniques included further chondrotomy and excision of deviated portion in 76% and caudal batten graft in 39%. Rhinoscopic and endoscopic exams showed straight septum in 97% and 92 patients had subjective symptom improvement postoperatively. Conclusion. Middle septum and caudal septum were common sites of persistent deviation. Proper chondrotomy with excision of deviated middle septum and correction of the caudal deviation with batten graft are key maneuvers to treat persistent deviation.

• Archives of Plastic Surgery
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• v.45 no.4
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• pp.379-383
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• 2018

Septoplasty/septorhinoplasty is a common ear, nose and throat procedure offered for those patients with deviated septum who are suffering from nasal obstruction and functional or cosmetic problems. Although it is a basic and simple procedure, it could lead to catastrophic complications including major skull base injuries which result in cerebrospinal fluid (CSF) leaks. We describe two different cases of traumatic CSF leaks following septoplasty/septorhinoplasty at two different sites. The first patient suffered a CSF leak following septoplasty and presented to Alexandria University Hospital. The leak was still active at presentation and identified as coming from a defect in the roof of the sphenoid sinus and was repaired surgically. The second patient presented 4 days after her cosmetic septorhinoplasty with a CSF leak and significant pneumocephalus. She was managed conservatively. Understanding the anatomical variations of the paranasal sinuses and implementing proper surgical techniques are crucial in preventing intracranial complications when performing either septoplasty or septorhinoplasty. A good quality computed tomography of the nose and paranasal sinuses is a valuable investigation to avoid major complications especially CSF leaks following either procedure.