crooked nose surgery
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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. 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.  

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