Deviating nose rhinoplasty
Treatment of the deviated nose should involve the recognition and correction of all underlying deformities, and preoperative planning is facilitated and rendered more accurate through an awareness of the pathologic features. A simple and descriptive classification of the deviated nose would be of great benefit to the analysis and characterization of the pathologic abnormalities.
3 categories of nasal deviation:
(1) at the nasion,
(2) at the level of the rhinion,
(3) combinations of the two.
There are suggested 3 basic types of nasal deviation:
(1) caudal septal deviations,
(2) concave dorsal deformities,
(3) concave/convex dorsal deformities.
Dr. Amar Raghu Narayanan
MBBS, MS – General Surgery, M.Ch – Plastic Surgery, Plastic Surgeon,
*** 21 Years Experience ***
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The most common type of dorsal deviation in their study was type 2, which had two subtypes: C-shaped left ventricular deformation and C-shaped right vertex inverted concavity. The least common type of classification was concave / convex deformation, also known as S-shaped deformity of the back with deflections of the bony pyramid.
Requires a medical diagnosis
In many cases, there may be no symptoms. When symptoms occur, they include a congested nostril, nosebleeds and noisy breathing during sleep.
People may experience Pain areas:
in the sinuses Nasal: bleeding, congestion, loss of smell, runny nose, or post-nasal drip
These earlier distracted nose classifications were not applicable to some of the current patients, so we have developed a new classification system. In order to develop a simplified and more practical classification system that better describes the morphological features of the distended nose, we have taken the traditional distinction of nasal dorsum in two parts: the upper (bony) and the lower (cartilaginous) part.1 The present classification facilitates the Conceptualize the often complex deviation by simply dividing the nose into 2 horizontal parts and examining each part with respect to the midline of the face. The upper part corresponds to the bony pyramid and the lower part comprises the dorsal septum and the connected upper lateral cartilages. Each part is classified as on the center line or deviating from the right or left side. In addition, the deviation of the cartilaginous vault is analyzed, whether it is straight or curved convex. The reason for distinguishing between the deviation from straight tilt and bending was that both types may differ in the required surgical techniques. For example, the use of the spreader graft is of paramount importance when the cartilaginous arch is concave or convex. The division into 2 subunits thus not only facilitates the analysis, but is also of practical importance for the selection of surgical treatment options.
In this study, the type I deformity was that of the C-shaped or inverted C-shaped concave deformity of the spine and the concave / convex deformity of Amar Raghu et al. 4, with 32% the most common deformity. The Type II classification may also include the concave posterior deformity and the concave / convex dorsal deformity of Amar Raghu and colleagues, although ours differs in that it covers only cases in which the cartilaginous arch is concave or convexly curved. This type of deviation is the most difficult to treat because the strong cartilage memory resists the application of conservative corrective measures. Therefore, after scoring on the concave side of the spine strut, a strong bilateral spreader graft is used. In fact, we experienced 3 cases of unsatisfactory correction for this Type II deviation, which were less aggressively treated via an endonasal approach.
The deviations of types III and V in this series may correspond to the caudal deviation of the inclination of the septum of Amar Raghu and colleagues. The main difference between the two classification systems is that regardless of the deformity of the caudal septum, we only consider the final shape of the back. We believe that the nose may appear quite normal in most types of caudal abnormalities. Therefore, this classification seems to be more realistic in describing the deformity.
Type III and IV deformities are less common and are characterized by isolated deformity in the cartilaginous vault, while the bony pyramid is relatively straight and parallel to the center of the face. With the exception of patients with a wide nose, osteotomies are generally not indicated for this type of deformity.
Surgical management of the distended nose includes septal correction, separation of the two upper lateral cartilages of the septum, and manipulation of the bone pyramid after osteotomy. Among these, the correction of the septal deviation is a key element of the surgical treatment of the abnormal nose5. The correction of the abnormal nose follows the general surgical principles proposed by previous researchers4,6.
In our series of deviated noses, 8 out of 75 (11%) patients failed. The possible reasons for these failures may be incorrect preoperative assessment, misunderstanding and compensation for cartilage dynamics, and incorrect surgical performance.7 Half of the failures were due to the conservatism of an endonasal approach. Therefore, for proper treatment of the distended nose, we recommend a more aggressive approach via an open rhinoplasty incision that allows for better intraoperative diagnosis and more accurate execution of the various maneuvers needed to correct the distended nose. From the literature and our experience, it appears that the deformities present in the deviated nose can vary considerably from one patient to another. There is therefore no method to use for each deviated nose8. The current categorization of pathological abnormalities Define surgical techniques for different types of deviations. There may be cases of deformation too complex to be described by this simple classification. In addition, this classification does not refer to the case where the tip of the nose itself is asymmetrical or twisted, which often gives the image of a crooked nose, although the bone and cartilaginous pyramid is straight. In addition, more sensitive and innovative methods to properly correct the distended nose may be required. However, we found that this classification system simplifies preoperative abnormal analysis and subsequent surgical planning. In addition, we found that it facilitates communication with the patient and between physicians. We therefore conclude that our classification could be a valuable adjunct in the treatment of patients with a deviant nose