The Crooked Nose in Rhinoplasty

Dallas Plastic Surgeon, Dr Steve Byrd, discusses his publications on the correction of the crooked nose as relates to deviation of the nasal septum.

The crooked nose is secondary to deviation of the bony and/or cartilaginous septum. It may be caused by trauma or occur spontaneously. Some have attributed the non traumatic occurrence of septal deviation to dislocation of the septum occurring during birth trauma but not manifesting until growth and development following puberty. Clearly, childhood nasal trauma can lead to the occurrence of septal deviation in adolescence. It may also be caused by asymmetric development of the facial bones and by unilateral partial or complete facial paralysis. Cleft lip and cleft palate will also cause deviation and deformity of the nasal septum (see cleft nasal deformity).

Unfortunately, the recurrence of septal deviation is reported as high as 30% following rhinoplasty (nose job). I believe this is the result of techniques that rely on septal cartilage scoring as a sole means of straightening the deviation. While scoring appears to correct the deviation at the time of surgery, if the deforming forces are not released, the weakened (scored) cartilage is prone to relapse. I believe the deforming forces must be fully released and the deviated septum strengthened by adding septal cartilage grafts. (Byrd HS, Salomon J, Flood J: Correction of the crooked nose. Plast Reconstr Surg 1998 102(6):2148) The recurrence with these techniques is less than 5%. Compared to camouflage techniques using ear or septal cartilage grafts to hide the deviation, I believe both the functional and aesthetic results are superior.

Byrd HS, Andochick S, Copit S, Walton G: Septal extension grafts: a method of controlling tip projection, rotation, and shape. Plast Reconstr Surg 1997, in press

Byrd HS: Secondary Rhinoplasty (Expert Exchange). In: Saleh M. Shenaq (ed), Perspectives in plastic Surgery. New York, Thieme, 2000 Vol 14(1)pp 87-100

Byrd HS: Use of Resorbable Spacers for Nasal Spreader Grafts (Discussion). Plast Reconstr Surg 2000 Sept 106(4);929.

Byrd HS: Morphologically prone nasal tip. Operative Techniques in Plastic and Reconstr Surgery Nov 2000, Vol 7(4) pp 208 212