A crooked nose can cause both aesthetic and functional issues, which can be corrected through surgery. The surgical approach for correcting a crooked nose varies depending on the degree of curvature.
For mild nasal curvature, to straighten the crooked bridge without fracturing the nasal bone, cartilage or dermal fat grafting may be performed on the nasal bridge. Alternatively, rhinoplasty with implant placement can be used to augment depressed areas or reduce prominent areas to correct the deviation. When accompanied by a low nasal bridge, simultaneously performing augmentation during deviation correction yields ideal results.
Incisions for Crooked Nose Correction
After routine disinfection and anesthesia, note that incisions can be made via either an intranasal or external approach, each with distinct advantages.
The external approach employs a U-shaped incision at the columella, extending to the anterior margins of both alar cartilages. Subcutaneous tissue is then dissected upward, providing excellent exposure of the surgical field.
The intranasal approach involves making curved incisions along the upper margins of the alar cartilages within the bilateral nasal vestibules. These incisions are then connected by passing through the anterior margin of the septal cartilage. Once the incisions are completed, subcutaneous tissue can be extensively dissected upward to expose the piriform aperture and lateral nasal soft tissues up to the nasal bone. Care must be taken to avoid manipulating the nasal dorsum skin during this step.
Management of the Nasal Bone Wedge for Deviated Nose Correction
Depending on the degree of deviation, use a bone chisel or saw to cut through the maxillary frontal process and nasal bone from the edge of the piriform aperture upward. Grip the upper end of the nasal bone with bone forceps and twist to fracture it. The nasal cone will then become mobile. Manually reshape the nose with fingers. Once the nasal contour is satisfactory, close the incision.
Postoperatively, symmetrical packing is placed in both nasal cavities to maintain the septum in the midline. The external nose is stabilized with molding plaster or a small splint under compression.
Patients require specific postoperative care to avoid nasal trauma and should minimize outdoor physical activities.