|
One of the most challenging aspects in rhinoplasty surgery is the crooked nose. The large number of keywords relating to this condition gives some indication as to the causes:
Synonyms and related keywords:
asymmetric nose, twisted nose, deviated nose, post-traumatic nasal deformity, crooked nose, deviated septum, nasal trauma, broken nose, external nasal deformity, nasal septal deviation, nasal fracture, fractured septum, crooked dorsum, deviated dorsum
 A twisted nose is often due to trauma; however, patients can be born with this deformity (congenital) either due to bony or cartilage abnormalities, as well as a deviated septum.
These structural issues often contribute to nasal obstruction, further complicating optimal surgical management. Although one may be tempted to focus on contour deformities, adequate care must also involve complete correction of nasal obstruction.
Causes: Trauma
Nasal bones are the most commonly fractured bones in the face, and fractured nasal bones are a leading cause of an asymmetric nose. Neglected or partially reduced nasal fractures usually result in a crooked nose associated with surface depressions and irregularities. These patients often present without prior medical attention, and many recount a history of progressive nasal changes following a traumatic event. Of the patients who do receive treatment following the incident, many find the treatment unsuccessful.
Patients with external nasal deformities frequently experience progressive nasal obstruction. Trauma leads to both septal deviation and disruption of traditional nasal support mechanisms. With loss of nasal support, internal and external nasal valve collapse may result.
These photos were taken from above and behind the subject elucidates crooked nose deformity.
Injury leading to a crooked nose may be secondary to a recent event or to years of scarring and contraction following previous trauma. Many people believe they were born with a deviated nose or that the condition was genetic; however, both patients and physicians alike frequently overlook childhood trauma as a common cause of crooked nose. Children are frequent recipients of trauma leading to progressive deviation. The noses of children are composed primarily of cartilage. The nasal bones are smaller, softer and more compliant. Birth trauma may result in nasal septal deviation. Nasal septal deformities are estimated to occur in 1.25-23% of newborns.
Diseases of the septum and internal nose
Diseases of the septum and internal nose may cause resorption of supporting structures leading to collapse of nasal valves and deviation. Autoimmune or immunologic diseases are classic examples of disorders resulting in septal injury. Other diagnostic considerations include drug abuse and cancer. Nasal inhalation of cocaine leads to ulceration of nasal mucosa. With consistent use, mucosal atrophy and septal perforation may occur.
Postsurgical
Many patients who seek either cosmetic or functional benefits of rhinoplasty are initially pleased with their new appearance. Years later, as the forces of healing begin to manifest, patients may become disappointed.
Rhinoplasty is a complex surgical procedure fraught with potential complications. Unfortunately, reduction rhinoplasty frequently results in loss of structural support and a weakened nose. A combination of scarring, gravity, and aging pulls the nose in different directions and can result in nasal collapse and deviation. Asymmetric or incomplete osteotomies result in deviation of the upper-third region of the nose and obvious step deformities. Despite complete and symmetric osteotomies, if the nasal structures responsible for the deviation are not corrected, the nasal pyramid may migrate back to its original position.
Surgical treatment of an operated nose can be difficult, as landmarks and tissue planes are unclear. The required approach and treatment plan must be strong in fundamental principles of returning nasal support and structure.
Osteotomies (cuts in the bone) are necessary to bring the crooked nose back into the midline.
Examination
During your examination, the outside and inside of the nose will be examined. A deviated septum may cause the air warming chambers to enlarge (turbinate enlargement) causing difficulty in breathing. Turbinates may need to be reduced at the time of your surgery.
Treatment
After consultation and examination, a treatment plan is formulated. The various approaches are discussed such as open versus closed rhinoplasty, and whether or not camouflage techniques will be used.
In open rhinoplasty (external rhinoplasty), an incision is made across the columella (structure between the nostrils) and the adjustments are made under direct vision. In the closed technique (endonasal rhinoplasty), instruments are placed through incisions within the nostrils, thus allowing modification of the bones and cartilages. With camouflage techniques, a straight bone graft is placed on top of the crooked bones to give the appearance of a straight line.
Reduction rhinoplasty refers to the taking down of certain portions of the nose such as the nasal bones for correction of a dorsal hump, or the tip cartilages for a boxy tip.
Augmentation rhinoplasty refers to the use of bony or cartilagiuous grafts to enhance certain deficient structures. Septoplasty refers to work on the nasal septum.
Postoperative Details:
Different types of internal and external splints are available depending on what was done. The splints help maintain nasal stability during the healing process. Internal nasal packing is often used. Nasal bleeding, bruising and swelling are common after this type of surgery. Pain is usually minimal to moderate and can be controlled by pain medications.
Packs are usually removed in 1-2 days. Healing takes place over the next 6 to 8 weeks, during which time there is progressively less swelling, and the adjusted nasal bones and nasal cartilages become solid.
Contact Us for More Information
For confidential personalized information and advice, please complete our information request form or call us at 1-800-640-0290 during business hours: Monday through Thursday 8:30 a.m. - 4:30 p.m. and Friday 8:30 a.m. - 4 p.m. EST. LATE AFTERNOON & EVENING HOURS NOW AVAILABLE .
The Plastic Surgery Center of Manchester, New Hampshire specializes in cosmetic plastic surgery, including body lifts, breast enlargements, breast lifts, breast reductions, eyelid surgery, ear surgery, facelifts, fat grafting, liposuction, male breast reductions (gynecomastia), neck and chin surgery, nose surgery (rhinoplasty), surgery after massive weight loss, tummy tucks and BOTOX® Cosmetic for vaginismus. We also offer facial rejuvenation (chemical peels, dermabrasion, Obagi Blue Peels, Glycolic Peels, Microdermabrasion), injectables and facial fillers (BOTOX® Cosmetic, Radiesse®, Juvederm®, Perlane® and Restylane®) and advanced skin care to patients from all over New England (Maine, Vermont, New Hampshire, Massachusetts). While no responsible practitioner gives guarantees for the work they do on the human body, we can at least reassure you that you will receive the expertise and dedication of over 30 years in practice. Our patients become an important part of our family and we try to get to know each patient individually and customize their treatment to meet their desires. Visit our skincare website to purchase MD Forte, Obagi-C Rx, Obagi NuDerm, Prevage and Vivite advanced skincare products.
|
