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Correction of Twisted Nose

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. Introduction. Understanding of nasal anatomy & physiology Accurate preoperative analysis & intraoperative diagnosis Precisely execute the surgical steps

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Correction of Twisted Nose

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  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)

  11. 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

  12. Classification of Twisted Nose

  13. 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.

  14. Type I

  15. Type II

  16. Type III

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

  18. 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.

  19. Results

  20. Results

  21. Results

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

  23. 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.

  24. Osteotome

  25. 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

  26. Autografts

  27. Types of grafts

  28. 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

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

  30. 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.

  31. Thank you for your attention

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