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A Combined Approach To Crooked Nose Deformity

Abstract

Background

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.

Results

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

Conclusions

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.

Level of Evidence V

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Acknowledgments

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.

Additional information

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

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

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). https://doi.org/10.1007/s00266-016-0627-8

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Keywords

  • Crooked nose
  • Twisted nose
  • Rhinoplasty
  • Extracorporeal septoplasty