Deviated nose

Written by Escobar MD     

In the case of the deviated or crooked nose, if look at yourself in the mirror and observe your nose from the font, you can divide it into 3 parts. The first one is bone, next is the cartilaginous part (it is the part after the bone that is softer and, as opposed to the previous part, can be moved).

Finally there is the nasal tip, which is the lowest part and is also made up of cartilage. Normally, if all this is well, these 3 parts or portions are perfectly aligned on the central axis of the face, in such a way that the nose will have a straight appearance.

WHAT IS IT ABOUT? Every alteration in the position, whether traumatic or congenital, of any of the portions that make up the nose in regards to the central axis of the face. Therefore, if this happens your nose will be deviated or crooked.

TYPES The normal scenario is that if the bone portion is deviated the second cartilaginous portion will also be, and not only this one, but it can also affect the position of the nasal tip. In this case there will surely also be breathing difficulty due to the septum deviation that usually goes with these alterations of the external shape of the nose. In this case, there will be a mixed deviation. Other times, only the cartilage part is deviated and not the bone part, also accompanied by some type of breathing problem, and the nasal tip can probably be deviated. This is a cartilaginous deviation. Last, it can also happen that the only thing that is crooked is the nasal tip, which can be due to a different conformation in the cartilages that make up the nose because of prior surgeries. It is frequent for the cause to be a prior surgery, whether because of a defect in the fracture technique, or the septoplasty technique, or as I was saying, the treatment of the nasal tip. Correcting a crooked or deviated nose is not easy, but in many of the cases a great improvement can be obtained. It is more difficult in other cases because factors such as the alteration of the development of the facial skeleton etc. come in. What is important here, as in every facial plastic surgery, is the good diagnosis. Based on this, it is important to plan carefully and chose the technique to be performed.

TECHNIQUES There are many surgical techniques that try to solve a crooked nose. Some are better than others, but what is important is choosing the best one for the specific case. In my case, I do the fractures in a continuous manner form inside the nose, using the Hinge technique with a subsequent fracture of the nasal spine of the frontal bone also from the inside of the nose. These techniques are very effective to solve this pathology, because they manage to completely mobilize the nasal pyramid while maintaining its stability. To correct the cartilaginous part of the nose it is important to correct the bone, as well as to use a good septoplasty technique that corrects the breathing difficulty that the patient may have. If the tip is not corrected after revising the bone and cartilage of the back, it may be necessary to revise the conformation of the cartilages that form it.

FOLLOW UP But the treatment of a crooked nose does not end there (with the surgery); postoperative care is very important because the healing of a rhinoplasty is a dynamic process. This means that if it there isn't an adequate follow-up, the tissues can have a certain memory and try to return to the prior position, not totally, but in a degree that affects the final results. The follow-up is very important on the first weeks, which is the period in which the fractures end their consolidation process and the tissues begin to heal.