Indications for Nasal Deviation Correction:
Nasal dorsum curvature or lateral deviation: External nasal asymmetry indicates the need for septal and nasal triangle correction surgery. Whenever possible, preserve the cartilage and bone of the nasal septum. This is because the septum serves as the primary support for the nasal dorsum and, in certain cases, acts as a cartilage donor site for subsequent procedures.For nasal obstruction caused by septal deformity, the causative cartilage segment should be excised, followed by septoplasty and correction of the external nasal deviation. Severe deviation and obstruction may require total septal resection, followed by trimming and grafting of septal cartilage to create free cartilage grafts for reimplantation into the septum.
Surgical Methods for Deviated Nose Correction:
1. Incision Selection: Following routine disinfection and anesthesia, note that incisions can be made via either an intranasal or external approach, each with distinct advantages. The external approach for deviated nose correction employs a U-shaped incision on the columella, extending to the anterior margins of both alar cartilages. Subcutaneous tissue is then dissected upward, providing excellent exposure of the surgical field.For the intranasal approach to correcting a deviated nose, an arc-shaped incision is made along the upper border of the alar cartilage within the bilateral nasal vestibules. This incision is extended through the anterior margin of the septal cartilage to connect both sides into a single incision. After completing the incision, subcutaneous tissue is extensively dissected upward to expose the piriform aperture and lateral nasal soft tissue up to the nasal bone. Care must be taken to avoid manipulating the nasal dorsum skin.
2. Cartilage cone management: After extensive dissection of the nasal cartilage and bony framework from the dorsal soft tissues, incise along the northern margin of the septal cartilage to detach the septal cartilage from the lateral nasal cartilage.Next, dissect the mucoperichondrial flap of the nasal septum from the wider nasal cavity side down to the nasal floor. Sever the anterior border of the septal cartilage and its attachments to the ethmoid vertical plate and sphenoid bone, rendering the septal cartilage semi-free.If necessary, tension-relieving incisions may be made on the septal cartilage to allow complete repositioning to the midline. For patients with a deviated nose exhibiting asymmetric lateral cartilages, excise the portion of the larger lateral cartilage extending beyond the midline to correct the deviation of the cartilaginous cone.
3. Bone Conus Management: Based on the degree of conus deviation, use a bone chisel or saw to sever the maxillary frontal process and nasal bone from the edge of the piriform aperture upward. Grip with bone forceps and twist to fracture the upper end of the nasal bone. The conus will then become mobile. Manually manipulate and reshape the nasal structure with fingers. Once satisfactory correction is achieved, 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 paste or a small splint under pressure. Following completion of all procedures, routine postoperative care is administered. External nasal dressing is removed after 10 days.