Rhinoplasty and Septoplasty Straightening of the Crooked or Deviated Nose
Both rhinoplastys and septoplastys are commonly performed in order to straighten crooked or deviated noses. There are many factors that result in a nose that is not straight and there are many surgical techniques that can be used in order to correct these deformities. As always, the treatment is specifically catered to the underlying cause. A surgeon starts by eliciting a patient’s history of trauma or prior surgeries in an attempt to determine a cause. In addition, findings on physical exam are extremely important. Based on these findings, a rhinoplasty surgeon can determine what exactly is causing a nose to be crooked and what needs to be done to make it straight.
The surgical correction of a crooked nose begins with an open rhinoplasty approach. Opening the nose and separating it into its individual components can identify the exact cause of the deviation. Occasionally, the deviation is a result of displaced nasal bones. More commonly, a deviated nose is the result of abnormalities in the patient’s nasal septum. If the nasal bones are displaced, they usually need to be fractured and moved into the correct position. If the septum is deformed, a more complex reconstruction is required.
The first step in straightening the septum involves removing the most abnormal part. This will occasionally free the remaining septum enough to straighten the nose. Usually, additional techniques are required. The next step is to reposition the septum to ensure that it is in the midline of the patient’s face. Once the septum is free from the surrounding tissue and in the midline, additional contour irregularities need to be corrected by operating on the septum directly. The septum can be cut and sutures and grafts can be added to it. If none of these techniques are able to accomplish the surgical goals, the septum can be removed entirely from the patient’s face. Once it is removed, it can be cut, sutured and grafted while outside of the patient’s body in a procedure called an extracorporeal septoplasty. During this procedure, the septum can be reconstructed and made almost completely straight prior to replacing it in the nose and securing it to the surrounding structures. Extracorporeal septoplasty is an extremely complicated and challenging procedure that few surgeons are willing to perform. The photographs shown below demonstrate an extracorporeal septoplasty that Dr. Morin performed in order to straighten a patient’s extremely crooked nose. The after photograph demonstrates the impressive result Dr. Morin was able to achieve using this expert level technique.