Introduction
Crooked nose deformity is a vertical axis deviation of the nasal pyramid on basal and/or frontal views and is still a challenging problem for rhinoplasty surgeons. Despite all technological, anatomical and surgical advancements, achieving a straight nose may not be possible in a significant group of patients. Several techniques, such as double or asymmetric osteotomies, spreader grafts, cartilage scoring, and several onlay graft techniques, have been described in the literature(1-4). Since a significant number of patients still undergo revision surgeries for crooked nose, we believe that this problem has not yet been fully resolved.
The nasal pyramid has 3 sections: the upper, middle and lower thirds. Deviations may be seen in all three sections. Upper-third deviations are generally caused by bony pyramid deviations, and lower two-third deviations are caused by cartilaginous and soft tissue structures (5). Preoperative analysis of deviation on nasal bones and cartilaginous structures is very important and essential to resolve this problem.
There are 4 different types of crooked nose deformities described in the literature. (2,6,7,8)
Cartilaginous type: The deviation only involves less than 2/3 of the cartilaginous structures of the nose. There is no deviation on the bony part.
Linear type (I-shaped): The nasal axis is deviated to one side with a linear shape.
C-shaped: The major etiological reason for this most frequent type of deviation is septal cartilage fracture. The vertical axis of the nose is C-shaped, and the concavity may face the right or left side.
S-shaped: This most complicated type has different angulations and deviations on 1/3 of the nasal pyramid.
Compared with classical structural rhinoplasty techniques, preservation rhinoplasty is a very popular technique and has many advantages, such as achieving a more natural middle vault (9,10). In our technique, the middle vault is preserved, the bony cap is mobilized and preserved, and the lateral nasal bones are equalized by a piezo device or classical osteotomes. By the mobilization of the bony cap, tension on the dorsal septum is released, and slight asymmetries are hidden behind this mobile bony cap. Here, we present our I- and C-shaped crooked nose rhinoplasty results with this new osteotomy technique.