A Systematic Analysis of the Nasal Septum in Crooked Noses and Suggested Treatment Algorithm According to Preservation Rhinoplasty (PR) Principles

Abstract

Background A deviated nose is a common problem among patients for both cosmetic and functional reasons. The correction remains a major challenge for the rhinoplasty surgeon. Unrecognized nasal septal deviations stand as the primary reason for failed rhinoplasty outcomes. There is a paucity of data in the literature about septoplasty classifications and technical details in preservation rhinoplasty (PR) for various crooked noses. Materials and Methods The aim of this article is to provide a comprehensive overview of the various septum deviations according to the nasal axis. Moreover, a treatment algorithm is suggested with technical details based on PR principles. Results The directions and curvature of the cartilaginous deviation of crooked nose such as C-shaped, reverse C-shaped, straight axis deviations (I-shaped), and S-shaped are described. According to the deviation, a septoplasty classification (Type 1–Type 4) is suggested. Conclusions On the basis of septal deviation, different PR techniques are proposed to achieve the desired straight nasal dorsum with an optimal functional outcome. Compared to the classical L-strut concept, the quadrangular cartilage remains preserved in the swinging door technique. The cartilage might be further used in the future for grafting in the hybrid structural/preservation technique if needed, ultimately saving rib cartilage and/or conchal cartilage. Finally, surgery time is reduced, and patient’s morbidity remains minimal. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The Creation of an Average 3D Model of the Human Cartilaginous Nasal Septum and Its Biomimetic Applications

“…Septal shape is often only addressed in the context of septal deviation pathology, which focuses on the coronal plane. However, to the best of our knowledge, the overall shape of the healthy cartilaginous septum in the sagittal plane has not been reported [5]. Given that the contour and angulation of the L-strut is largely dependent on the native septal shape, expanded knowledge of the septal shape would improve our biomechanical understanding of the L-strut.…”