Significant deviation of the nasal bone remains a challenging problem in rhinoplasty and diagnosis is the first step toward correction. Nasal bone and cartilage have separate elements, both of which, which can lead to a crooked nose. Effects can include deformities of the nasal septum, fractures of nasal bones, and asymmetries of the upper and lower lateral cartilages. Whether these effects result from traumatic or congenital forces, the goal of a corrective procedure is to produce a functional nasal airway and a visually appealing nose.
A pre-operative, systematic approach to the diagnosis and repair of a crooked nose will lead to noticeable results. The surgeon will consider subjective goals of the patient, evaluate the objective appearance of the nose, and discuss the possible technical options. Although preoperative assessment is often adequate for identifying simple, anatomical problems, there is no substitute for direct visualization. Therefore, Dr. Sadati advocates open approach rhinoplasty to correct severely crooked or twisted noses.
The systematic diagnosis approach proceeds in a logical sequence.
Assess the adequacy of the nasal airway; many crooked noses have functional airway deficits best addressed by septoplasty.
If the airway is adequate, determine whether the septal cartilage deviation contributes to the twisted deformity or whether septal grafts will be required.
Determine if nasal support is sufficient. If it is not, other techniques such as bone grafting must be considered.
Patient Evaluation and Diagnosis
A patient undergoing a corrective procedure for a crooked nose should have reasonable expectations. And as always, education is a key component. Patients should understand that the nasal septum is a major structural support system. Teaching rhinoplasty candidates about surgical limitations helps to create reasonable postoperative expectations.
Approaches to Correct a Crooked Nose
It has been shown that nearly any deviation of fractured nasal bones involves a resulting fracture of the associated septal cartilage. Therefore, correcting the septum is usually the first step toward producing a functional airway. Shoring up the nasal supports is imperative or the nose may drift back to its original and unsatisfactory position.
