Surgical Technique
After preparing the surgical field, patients were covered with sterile
surgical cloths. After local anesthetic administration, the closed
approach let-down technique is preferred. Infracartilaginous and
marginal incisions were applied. Supraperichondrial and subperiosteal
dissection was performed carefully. Wide subperiosteal dissection is
essential for better visualization and control of lateral osteotomies
and ostectomies. First, the lateral nasal walls were measured and
recorded. Planned lateral nasal walls were calculated according to the
hump and equalized on both sides. First, osteotomies were localized 2-3
mm below the bony cap and with an average of 8 to 10 mm in size, and
their connection with the upper lateral cartilages was preserved on both
sides. Mobilization of the bony cap allows the cartilage to move freely,
and this maneuver helps the correction of the middle third deviation.
Subsequently, we left 15 to 18 mm of lateral nasal bone on both sides
with an equal size and shape just below the mobile bony cap and took the
excessive bones between the lateral osteotomy lines and maxillary bone
to prevent step deformities and the recurrence of deviations. Bony
pyramid deviation is corrected with this asymmetric reduction of the
bone on both sides. The important point is that the residual lateral
nasal bone sizes left in the patient should be equal for symmetry. Lower
strip resection of the septum and a lower strip cut in the perpendicular
plate of the ethmoid bone were performed, and the let-down procedure was
completed. In our technique, to correct the 3-dimensional asymmetry in
the lateral nasal bones, the dimensions of the lateral nasal bones are
measured and equalized. The bony cap is mobilized and preserved to hide
the slight asymmetries below and release the tension on the dorsal
septum. A schematic diagram of the surgery is provided in Figure 1.
The SPSS statistical package (version 15.0; Chicago, IL) was used for
all data analyses. Preoperative and postoperative angles were compared
by a dependent t test for both I- and C-type deformities separately, and
a statistically significant p value was accepted as <0.05.