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A Combined Approach To Crooked Nose Deformity

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Crooked nose deformity is a complex anatomical deformity; therefore, repair remains a challenge. Here, we introduce a new technique for crooked nose deformity repair.

Materials and Methods

Twenty-two patients underwent intraoperative evaluations and measurements, followed by surgery using the open rhinoplasty technique. Our method involves three major steps. First is the creation of an asymmetric medial oblique osteotomy using piezoelectric ultrasonic surgery and double lateral osteotomies, wherein the asymmetric bony ascending part of the maxillary bone at the base of the nasal vault is fractured, pushed in, and delivered to the face. Second is septoplasty with L-strut preservation. The L-strut is removed as a 1-cm block caudally from the septal stump of the keystone area. A (or double) fabricated batten cartilage graft is placed on the concave side of the deviation and sutured to cover the septal stump. The L-strut is then replaced and sutured on the batten graft, redirecting the septum toward the midline. Third is an overlapping cruroplasty on the side of the long asymmetrical lower lateral cartilage to equalize both wings and correct tip deviation.


Our new technique was effective for the treatment of crooked nose deformity.


Our technique of K-stone batten plasty with delivery to the face and overlapping cruroplasty may be an effective surgical method for crooked nose deformity.

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  1. Inanli S, Sari M, Yanik M (2009) Intraoperative evaluation and measurement of a crooked nose. J Craniofac Surg 20:985–986

    Article  PubMed  Google Scholar 

  2. Rohrich RJ, Gunter JP, Deuber MA, Adams WPJ (2002) The deviated nose: optimizing results using a simplified classification and algorithmic approach. Plast Reconstr Surg 110:1509–1523

    Article  PubMed  Google Scholar 

  3. Byrd HS, Salomon J, Flood J (1998) Correction of the crooked nose. Plast Reconstr Surg 102:2148–2157

    Article  CAS  PubMed  Google Scholar 

  4. Hsiao YC, Kao CH, Wang HW, Moe KS (2007) A surgical algorithm using open rhinoplasty for correction of traumatic twisted nose. Aesthet Plast Surg 31:250–258

    Article  Google Scholar 

  5. Gunter JP, Rohrich RJ (1988) Management of the deviated nose. The importance of septal reconstruction. Clin Plast Surg 15:43–55

    CAS  PubMed  Google Scholar 

  6. Murakami WT, Wong LW, Davidson TM (1982) Applications of the biomechanical behavior of cartilage to nasal septoplastic surgery. Laryngoscope 92:300–309

    Article  CAS  PubMed  Google Scholar 

  7. Gilbert SE (1998) Overlay grafting for lateral nasal wall concavities. Otolaryngol Head Neck Surg 119:385–388

    Article  CAS  PubMed  Google Scholar 

  8. Gubisch W (1995) The extracorporal septum plasty: a technique to correct difficult nasal deformities. Plast Reconstr Surg 95:672–682

    Article  CAS  PubMed  Google Scholar 

  9. Gurlek A, Celik M, Fariz A, ErsÖz-Öztürk A, Eren AT, Tenekeci G (2006) The use of high-density porous polyethylene as a custom-made nasal spreader graft. Aesth Plast Surg 30:34–41

    Article  Google Scholar 

  10. Gubisch W (2015) Treatment of the scoliotic nose with extracorporeal septoplasty. Facial Plast Surg Clin North Am 23(1):11–22

    Article  PubMed  Google Scholar 

  11. Andre RF, Vuyk HD (2006) Reconstruction of dorsal and/or caudal nasal septum deformities with septal battens or by septal replacement: an overview and comparison of techniques. Laryngoscope 116:1668–1673

    Article  PubMed  Google Scholar 

  12. King ED, Ashley FL (1952) The correction of the internally and externally deviated nose. Plast Reconstr Surg 10(2):116–120

    Article  CAS  Google Scholar 

  13. Porter JP, Toriumi DM (2002) Surgical techniques for management of the crooked nose. Aesthetic Plast Surg 26(Suppl 1):S18

    Article  PubMed  Google Scholar 

  14. Toriumi DM (2013) Subtotal septal reconstruction: an update. Facial Plast Surg 29(6):492–501

    Article  CAS  PubMed  Google Scholar 

  15. Sheen JH (1984) Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 73(2):230–239

    Article  CAS  PubMed  Google Scholar 

  16. Boccieri A, Pascali M (2003) Septal crossbar graft for the correction of the crooked nose. Plast Reconstr Surg 111(2):629–638

    Article  PubMed  Google Scholar 

  17. Gerbault O, Daniel RK, Kosins AM (2016) The Role of Piezoelectric Instrumentation in Rhinoplasty Surgery. Aesthet Surg J 36(1):21–34

    Article  PubMed  Google Scholar 

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The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Correspondence to Adem Binnetoglu.

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The authors have no potential conflict of interest.

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This work was done in Marmara University Pendik Training and Research Hospital.

Electronic Supplementary Material

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Intraoperative evaluations and measurements with identification of the F1 and F2 lines and “delivery to the face” area (MOV 44567 kb)

Intraoperative illustration of K-stone batten plasty (MOV 68866 kb)

Use of piezosurgery in crooked nose deformity. Bone chip extraction, medial oblique osteotomies, transection and extraction of the L-strut, double batten insertion and fixation, replacement of the L-strut and formation of neo K-stone area, thinning of the neo K-stone area (MOV 129039 kb)

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Inanli, S., Binnetoglu, A. A Combined Approach To Crooked Nose Deformity. Aesth Plast Surg 40, 360–366 (2016).

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