Crooked Nose: Effective Treatment Strategies for Bony Contouring

Introduction

Almost every osseocartilaginous vault is asymmetric. This emphasizes the importance of individualized osteotomy when performing rhinoplasty. Specific anatomical variations in the bony vault such as width, length and height should be considered when selecting specific osteotomies. Osteotomies should no longer be thought of as an automatic step in rhinoplasty. Instead, they should be completed in an individualized fashion based on the anatomy of each side of the nose.

Anatomic and Clinical Considerations

A crooked nose or a deviated nose can have multiple elements that each needs to be addressed independently. These include deviation of the septum, and deviation and asymmetry of the nasal bones. In this chapter, our main focus will be on the deviation and asymmetry of the nasal bones. However, it is worth mentioning that the deviation and crookedness of the septum needs to be corrected prior to addressing nasal bony deviation.

Nasal osteotomy should involve a component-oriented and individualized approach. In order to truly appreciate the details of nasal osteotomies, one should review normal anatomy and the anatomy of the osseocartilaginous regions following hump reduction and the osteotomies that are typically performed during primary rhinoplasty (See c00291, c00292, c00293, c00294, c00295 ).

When there is a significant asymmetry of the lateral nasal wall, for example in the region of the ascending process of the maxilla, then asymmetric osteotomies are indicated. In a previous study we demonstrated that in about 20% of patients, unilateral and asymmetric base osteotomies are needed. Furthermore, anatomic studies have revealed that no two nasal bones are identical, thereby necessitating doing individualized osteotomies.

Types of Osteotomies