Repairing the Externally Crooked Nose: Are There Any Straight Answers?

Program Description: The crooked nose—and its aesthetic and functional issues—is a challenge frequently encountered by practicing otolaryngologists. Repair is not always straightforward and residual deformities can be distressing for the patient as well as the surgeon. With the prominence of the nose as a central defining feature of the face, any deviation is easily recognized since it detracts from overall facial symmetry. The purpose of this miniseminar, created by the Facial Plastic and Reconstructive Surgery Education Committee, is to shed light on the diagnostic and technical challenges of repairing the crooked nose. Panelists will focus on careful analysis of the anatomic factors responsible and highlight a repertoire of corrective surgical techniques. Discussion of the topic will be divided into the various thirds of the nose: the bony nasal vault, the cartilaginous mid-vault, and the nasal tip and caudal septum. Management strategies to be discussed include new osteotomy techniques, suture techniques, cartilage grafting, extracorporeal septoplasty, and tip-plasty. In contrast to the external rhinoplasty approach, the endonasal approach provides an alternative strategy—and perhaps a different philosophy—to addressing asymmetries of the nose. The role of endonasal rhinoplasty techniques will be presented. Whenever possible, literature will be referenced to support the discussion. The crooked nose is often caused by a complex interplay between bony and cartilaginous deformities, as well as scarring forces especially in traumatic and revision cases. Surgical strategies combine anatomic restoration with camouflage. A surgical plan requires not only an understanding of operative technique but also an understanding of the surgical expectations of the patient. Therefore, cases and patient scenarios will be presented by the moderator to the panelists (and the audience) for discussion. This miniseminar hopes to provide a nuanced understanding of rhinoplasty concepts and techniques that would be appreciated by seasoned surgeons and provide insight to the novice. Educational Objectives: 1) Recognize the various deformities and anatomic factors responsible for the crooked nose. 2) Learn to correct the bony nasal vault, cartilaginous mid-vault, and nasal tip and caudal septum. 3) Appreciate benefits and limitations of the external versus endonasal rhinoplasty approach to straighten the nose.