crooked nose

1. Dr saud aldhabaan
KFMC , FACIAL PLASTIC SURGERY
Crooked nose

2. Treatment of crooked nose remains one of the most
challenging problem in rhinoplasty

3. Etiology
 Congenital => facial asymmetry
 Traumatic
 Iatrogenic

4. Congenital crooked nose
 Treatment of congenital crooked nose can difficult
since the surrounding deviation of internal and
external facial framework makes it difficult to find
a common midline

5. Traumatic crooked nose
 Low velocity => simple unilateral infractiong of
affected nasal wall
 High velocity => bilateral nasal wall deviation
alonge with deviation of nasal septum

6. Iatrogenic crooked nose
 Caused by previous surgery may be by
 1) poorly executed Osteotomies
 2) excesses resection of nasal bone or cartilage
 3)poor wound healing

7. septum
 Severely deviated nose almost has major septal
deformity

8. History taking
 Detailed hx
 1) medical condition
 2)previous nasal surgery
 3)nasal trauma
 4)nasal airway
 5)allergy and drug
 6) tobacco use

9. Physical exam
 Surgeon should establish the midline of the face
 Vertical line drawn through from the glabella
through the philtrum and through the menton can
give the doctor a sense of weather the nose is
crooked .
 It also help identifying asymmetries

10. Vertical line drawn through from the glabella through the
philtrum and through the menton

11. Physical exam
 Nose divided in to thirds
 Upper => nasal bone
 Middle => septum and ULC
 Lower => septum and LLC

12. Physical exam
 Palpation
 Feel caudal septum
 Tip recoil
 Thickness of skin

13. Physical exam
 Endonasal exam
 Septum
 Valve
 Turbinate
 Nasal mucosa

14. Treatment strategy
 septum
 Upper third
 Middle third
 Lower third

15. septum
 Septoplasty
 Approaches : endonasal / external
 If septal deviation is sever and surgeon is unable
to correct it he can considers extracorporeal
septoplasty

16. Upper third
 Bony nasal framework
 Nasal bone articulate with ascending process laterally and frontal
bone superiorly
 Correction
 Rasping /medial /intermediate / lateral / transverse
 Another option for crooked upper nasal third is to camouflage the
deviation with bony reduction on the convex side and onlay
cartilage graft on the concave side

17. Middle third
 Composed of
 1) ULC
 2) dorsal septum
 Correction
 1) spreader graft (unilateral / bilateral)
 2) onlay camouflage graft
 Decision to use an onlay graft versus a
spreader graft is based on patient nasal
airway , size of depression and the shape of
ULC.

18. Lower thrid
 Consists of
 1)LLC
 2)caudal nasal septum
 3) nasal spine
 Deviation of lower third are often due to deflection
of the caudal septum or deviation of LLC
“asymmetry”
 Correction
 Graft (columellar strut , lateral crural strut )
 Suture shaping techniques

19. Sammary
 Methods of correcting for crooked nose
 1) hump reduction
 2) septoplasty
 3) Osteotomies
 4) spreader graft
 5) camouflage