Crooked Nose Defined

The term “crooked nose” is commonly used for all of the clinical conditions involving deviation of the nasal pyramid from the median line 1. In these cases, it can appear vaguely C-shaped or S-shaped or wholly displaced to one side or the other.

The consequences for the patient are severe in both functional and aesthetic terms, as great difficulty in nasal respiration is always combined with unsightliness that cannot be hidden.

This pathology is frequently found in clinical practice today as the result of blunt trauma from sports or car accidents. Still more important than the social aspect of the crooked nose is its psychological impact on the person concerned.

In our world, as we are all well aware, the face plays the crucial role in social relations as it is the first thing people see upon meeting. It is important for all of us to make a pleasing first impression on others in this sense, and the position of nose in the middle of the face means that any deviation is an unsightly element that immediately attracts attention.

It is therefore easy to see that people with this type of deformity can be prey to severe complexes and insecurity.

Therapeutic problems

While it is clear from a social and aetiopathogenetic viewpoint that the crooked nose constitutes a problem of present-day relevance, it is not equally clear and widely known that the associated therapeutic problem lies essentially in the risk of relapse 2.

In actual practice, what may appear to be a brilliant success immediately after surgery can be prove a failure a few months later on the reappearance of the deviation to some degree. This depends en tirely on the cartilaginous structures of the nasal pyramid, which retain the “memory” of the deviation due to their elasticity and tend to revert to their original position over time like a spring 3.

In physiopathological terms, this phenomenon is due to tissue deforming forces of an extrinsic and intrinsic nature that act on the cartilaginous nasal septum and cause relapse if they are not released during surgery. The extrinsic forces are those exerted on the septum by deviated nasal bones, upper lateral cartilages, and connections with the vomer, ethmoid and maxillary crest.

The intrinsic forces can be the result of imperfect growth of the septal cartilage or from trauma altering the tissue ultrastructure, after which the deviated cartilaginous tissue always retains an inherent tendency to revert to its initial position.

The bony structures of the nasal pyramid also involved in the deviation remain in their new position once they have been repositioned in the centre. At most, double lateral osteotomy can prove useful to allow a greater degree of mobilization and ensure the elimination of all anatomical defects.

The difficulty in solving the problem of the crooked nose lies entirely in the cartilaginous structure, and especially the dorsal section of the nasal septum. While a deviated nasal septum can in fact be largely removed from a functional standpoint, it is necessary in any case to leave an L-shaped structure capable of supporting the nasal pyramid as a whole.

In the case of the crooked nose, however, this structure must also be modified, as the deformity will otherwise remain present.

Another important therapeutic problem regards correction of the associated deformity of the upper lateral cartilages. The depression of the upper lateral cartilage on the concave side of the deviation is, in fact, often regarded as an indelible blemish even in cases where crookedness has been successfully corrected.

The reason for this is the difficulty of reshaping these cartilaginous structures, which are of reduced thickness and consistency. At the same time, the exclusive use of onlay grafts to camouflage crookedness advocated by some authors often proves inadequate due to problems of resorption, and because it can contribute even more to collapse of the upper lateral cartilage.

Surgical techniques

Numerous techniques described in the literature involve the use of sections, incisions and morselization to modify the cartilaginous portion of the dorsal pillar of the septum and straighten the nose 4 5. Unfortunately, these methods often prove unsuccessful due to the above-mentioned “memory” of the deviation and to excessive weakening of the supporting pillar leading to collapse of the nasal dorsum.

One technique offering good results involves extracorporeal reshaping of the nasal septum and grafting it back onto the nasal pyramid 6. In practical terms, the nasal septum is completely removed, reshaped and straightened outside the nose, replaced between the two mucoperichondrial flaps, and sutured into position inside the nose.

This makes it possible to reorientate the nasal septum and secure a straight, reshaped part of it in a dorsal position. The drawback of the procedure lies in the practical difficulty of obtaining perfect alignment of the graft with the surrounding structures and the risk of mobility over time.

Principles of Treatment

Correction of the crooked nose is one of the most challenging procedures in rhinoplasty. The goals of the surgery are creation of a rigid and straight cartilaginous L-strut, correction of the deviated bony structures, and improvement of the nasal airway. Curvatures of the dorsal septum can be corrected with several techniques. Spreader grafts, cartilage batten grafts, or ethmoid bone grafts can be utilized for internal stenting to straighten the dorsal deviations.

Crooked nose surgery also known as rhinoplasty for a nose that is crooked, is the corrective procedure for altering the crookedness. It involves nose rectification and reconstruction to give the nose a normal shape. Nowadays, nose jobs are common especially among the young generation with specific ideas about the definition of beauty derived mostly from the media.

This said crooked nose surgery could be the solution for many women. Many women go through life hating their crooked looking nose. They are self-conscious about their condition and some even might find it difficult to interact normally in social situations, particularly towards the opposite sex.

The surgical treatment for a deformed caudal septum with the most predictable and successful outcome is resection and replacement with a straight septal cartilage graft. In severe deviations of septum cartilage involving both dorsal and caudal portions of the L-strut, extracorporeal reconstruction of the septal cartilage may be the required method. For correction of the deviated bony pyramid, several osteotomy methods can be employed.

Medial osteotomy, low-to-low or low-to -high internal lateral osteotomy, double-level lateral osteotomies, and external lateral osteotomy are the options, depending on the deformity. Dorsal onlay grafts can provide camouflage for any residual asymmetries after septal reconstruction or can be applied for dorsal augmentation.

Crooked Nose Causes

A nose that is crooked can be caused by trauma. Nasal bones are the most commonly fractured bones in the face, and fractured nasal bones are a leading cause of a crooked nose. People in high-risk careers, such as boxers most often than not have suffered from a broken nose. When the bone heals, it would most likely not go back to its normal location, giving the nose a crooked appearance. Disregarded or reduced nasal fractures usually result in a nose that is crooked associated with surface dents and abnormalities.

Some noses become crooked at a young age as the nasal bones of children are soft and the slightest trauma during childbirth or play could damage the shape of the nose. The septum may also be deformed or infected with syphilis leading to malformation. Practices such as abuse of cocaine could lead to the formation of ulcers, which could permanently deform the nose.

It could also be a result of rhinoplasty gone wrong. Cosmetic surgery is a very delicate procedure and the slightest slip-up during surgery could leave the beauty seeker with a such a nose for life.

Note: The risk is that the surgery could be badly botching end especially if your surgeon is unqualified or inexperienced. Quality surgery from a quality surgeon could cost a lot and few women would afford this. Or you could take a chance and get rid of your crooked nose for good.

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