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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