An Initial Survey of Septorhinoplasty in Crooked Nose Deformities

Abstract

Objectives: Crooked nose deformity is a commonly seen reason for septorhinoplasty in the otolaryngology clinic. The purpose of this study is to initially determine the different etiologies of patients with crooked nose deformities who underwent septorhinoplasty, and to describe the different types of crooked nose by their level of deviation and surgical management in our institution.
 
 Methods:
 Study design: Case Series
 Setting: Tertiary Public University Hospital
 Subjects: A chart review of all patients with a crooked nose deformity who were admitted at the otorhinolaryngology ward of the National University Hospital and underwent septorhinoplasty from January 2012 to January 2015 was conducted, and data consisting of age, sex, etiology of crooked nose deformity, level of deviation, cartilage source, and surgical intervention were obtained and analyzed.
 
 Results: A total of 21 patients underwent septorhinoplasty for crooked nose deformity in the study period. The most common etiology for crooked nose was physical violence (13/21 or 62%), followed by sports injury (4/21 or 19%), vehicular accidents (2/21 or 9%), and accidental fall (1/21 or 5%). There were more upper and middle third deviations than lower third deviations. Sixteen out of 21 patients (76%) underwent open rhinoplasty, while the rest underwent an endonasal approach. Twelve (57%) underwent intervention on the nasal fracture after at least a year (old or neglected fracture) as compared to the 9 (43%) who had immediate intervention after less than two weeks. Thirteen used septal cartilage, while 4 used conchal cartilage, and 1 used tragal cartilage. The most common grafts used were spreader and camouflage, followed closely by dorsal onlay, and columellar strut grafts. 
 
 Conclusions: The majority of crooked nose deformities that were subjected to septorhinoplasty in our department were secondary to old nasal bone fractures caused by physical violence. Upper and middle third level deviations were more common, and most underwent open rhinoplasty with autologous cartilage grafts. Future studies may increase our understanding of, and improve our techniques in septorhinoplasty for crooked nose deformities in Filipino noses in particular, and Asian noses in general.
 
 
 Keywords: rhinoplasty, deviated nose, crooked nose, septorhinoplasty, nasal trauma

Crooked nose correction: an institutional experience

“…20 Endonasal rhinoplasty has a steeper learning curve and GMCH being a teaching hospital, the majority of our cases employed an open approach. 21 The open approach allows the surgeon to better diagnose the deformity through inspection, to better execute certain manoeuvres, and to teach and learn the operation with greater ease. 21 It may also be that revision rates for primary open approach are less than those for closed rhinoplasty.…”

“…21 The open approach allows the surgeon to better diagnose the deformity through inspection, to better execute certain manoeuvres, and to teach and learn the operation with greater ease. 21 It may also be that revision rates for primary open approach are less than those for closed rhinoplasty. 22 Extra corporeal septoplasty technique first described by Galloway and Fomon and popularised by Prof Wolfgang Gubisch is an excellent way for correcting severely deviated or angulated cartilaginous septum.…”