Types of Crooked Nose

Types of Crooked Nose (Figs. 9 – 1,2,15 to 29)

1. Crooked nose with hump.
2. Crooked nose with saddling.
3. Combination of hump and saddling.
4. Crooked nose with lateral depression.

Shapes of Crooked Nose

1. C- Shape
2. S- Shape
3. Straight deviated

Principles of Septorhinoplasty:

1. Improving function.
   • Adequate intranasal airways
   • Prevention of nasal valve collapse
2. Achieving satisfactory cosmetic results by keeping adequate nasal support.

Basic Management :

1. 1. Examination:
      1. Examine the dorsum and the nasal sidewalls and list the obvious deformities with good logical judgement :
         Hump – deviation _ depression _ asymmetry.
      2. Examine the nasal cavity with Nasal Endoscopy: assess the nasal septum deviation, enlarged turbinates, polyps formation, allergic rhinitis, mucoid or purulent fluids.

1. Operative Sequence:
   1. Endonasal approach: Intercartilagenous, transfixion and marginal incisions
   2. Septal correction
   3. Tip surgery
   4. Cartilagenous dorsum alignment
   5. Bony dorsum alignment
   6. Osteotomies
   7. Fine _ touch bony and cartilagenous dorsum alignment
   8. Closure
   9. Dressing

Fig. 9 – 3. Septoplasty
– Leaving adequate caudal margin in order to
prevent columellar retraction and dropped tip.
– Leaving adequate dorsal margin in order to
prevent supratip collapse.

Fig. 9 – 4.
Division of upper lateral cartilage from the septum. Stay as close to the septum as possible.