Correction of Twisted Nose

1. Correction of Twisted Nose • 台灣耳鼻喉頭頸外科醫學會105屆學術演講會 • 三軍總醫院耳鼻喉頭頸外科部 鄭立享 醫師 • 中華民國107年11月04日

2. Introduction • Understanding of nasal anatomy & physiology • Accurate preoperative analysis & intraoperative diagnosis • Precisely execute the surgical steps • Optimize both functional and aesthetic outcomes

3. Classification of twisted nose (1) at the nasion (2) at the rhinion (3) combinations of the two. The Journal of Otolaryngology 20:1, 1991

4. Classification of twisted nose(Cont.)

5. Classification of twisted nose Plastic & Reconstructive Surgery 110:1509-23; 2002

6. Classification of twisted nose(Cont.) Plastic & Reconstructive Surgery 110:1509-23; 2002

7. Classification of twisted nose (Cont.) Plastic & Reconstructive Surgery 110:1509-23; 2002

8. Classification of twisted nose Arch Otolaryngol Head Neck Surg 134:311-315; 2008

9. Classification of twisted nose (Cont.)

10. A new simple classification • Total 384 cases (M:314, F:70), mean age: 27 • Followed for 6 months to 71 months ( mean 21 months)

12. Classification of Twisted Nose • Type I : lower two thirds of nose • Type II : whole nose with same direction • Type III : whole nose with curved rhinion a: C-shaped b: reversed C-shaped

13. Classification of Twisted Nose

14. Type I is only deviated septal axis without deviated bony vault, and deviation can be linear, C-shaped, or S-shaped. • Type II and Type III is combined septal deformity and bony pyramid deformity.

15. Type I

16. Type II

17. Type III

18. Surgical Procedures • Septoplasty or Osteotomy & Septoplasty • Tip plasty • Closure and Fixation

20. Material & Method • Self-evaluation survey regarding satisfaction with nasal function and aesthetics • Preoperative and postoperative photography to judge objectively the aesthetic outcomes of the surgery.

21. Results

22. Results

23. Results

24. Results • Two patients with residual deviation of dorsum objectively who were satisfied the results after revision rhinoplasty.

28. Discussion • Medial osteotomies are necessary to free the nasal bones from the perpendicular plate of the ethmoid. • Lateral osteotomies are performed by high-low-high, low curved pathway. • Intermediate osteotomy usually was not necessary.

29. Osteotome

32. Discussion • a 12-mm (at least) L-shaped septal strut should be preserved to maintain the structure • Deformities of the cartilaginous dorsum are corrected by scoring along the concave surface of the septum

33. Autografts

34. Types of grafts

35. Discussion • Spreader graft straightening deviated septum recreating the esthetic dorsal lines restoring and maintaining the internal valve. 10 to 20 mm in length, 2 to 3 mm in thickness , and 3 to 4 mm in height

36. Discussion • Tip plasty caudal extension graft shield graft buttress graft lateral crural strut

37. Conclusion • This classification and surgical algorithm is simple and reproducible . • With an open approach, osteotomy, septoplasty, tip plasty, and dorsal augmentation can be performed precisely.

39. Thank you for your attention