Introduction
Crooked nose deformity is a vertical axis deviation of the nasal pyramid
on basal and/or frontal views and is still a challenging problem for
rhinoplasty surgeons. Despite all technological, anatomical and surgical
advancements, achieving a straight nose may not be possible in a
significant group of patients. Several techniques, such as double or
asymmetric osteotomies, spreader grafts, cartilage scoring, and several
onlay graft techniques, have been described in the literature(1-4).
Since a significant number of patients still undergo revision surgeries
for crooked nose, we believe that this problem has not yet been fully
resolved.
The nasal pyramid has 3 sections: the upper, middle and lower thirds.
Deviations may be seen in all three sections. Upper-third deviations are
generally caused by bony pyramid deviations, and lower two-third
deviations are caused by cartilaginous and soft tissue structures (5).
Preoperative analysis of deviation on nasal bones and cartilaginous
structures is very important and essential to resolve this problem.
There are 4 different types of crooked nose deformities described in the
literature. (2,6,7,8)
Cartilaginous type: The deviation only involves less than 2/3 of the
cartilaginous structures of the nose. There is no deviation on the bony
part.
Linear type (I-shaped): The nasal axis is deviated to one side with a
linear shape.
C-shaped: The major etiological reason for this most frequent type of
deviation is septal cartilage fracture. The vertical axis of the nose is
C-shaped, and the concavity may face the right or left side.
S-shaped: This most complicated type has different angulations and
deviations on 1/3 of the nasal pyramid.
Compared with classical structural rhinoplasty techniques, preservation
rhinoplasty is a very popular technique and has many advantages, such as
achieving a more natural middle vault (9,10). In our technique, the
middle vault is preserved, the bony cap is mobilized and preserved, and
the lateral nasal bones are equalized by a piezo device or classical
osteotomes. By the mobilization of the bony cap, tension on the dorsal
septum is released, and slight asymmetries are hidden behind this mobile
bony cap. Here, we present our I- and C-shaped crooked nose rhinoplasty
results with this new osteotomy technique.