Straight septum, crooked nose: an overlooked concept

Area of Science:

• Plastic Surgery
• Facial Anatomy
• Rhinology

Background:

• Asymmetric facial skeletal growth is prevalent in rhinoplasty patients.
• This asymmetry affects facial structures, including upper lateral cartilages (ULCs), leading to variations in thickness, consistency, curvature, and elastic recoil.
• Ignoring ULC asymmetry can significantly impact rhinoplasty outcomes, particularly for crooked noses.

Purpose of the Study:

• To evaluate the prevalence of asymmetric upper lateral cartilages (ULCs) in rhinoplasty patients.
• To determine the impact of ULC asymmetry on the management of crooked noses.
• To highlight the importance of correcting ULC asymmetry in rhinoplasty.

Main Methods:

• Retrospective review of 89 consecutive rhinoplasty patient files.
• Analysis focused on deformities of the middle vault and surgical procedures performed.
• Data collected on the presence and characteristics of asymmetric ULCs.

Main Results:

• Asymmetric ULCs were identified in 72 out of 89 patients (81%).
• A significant portion (30%) had a straight septum with asymmetric ULCs requiring correction.
• These findings underscore the commonality of ULC asymmetry in this patient group.

Conclusions:

• Awareness of asymmetric ULCs is critical for successful crooked nose surgery.
• Correcting ULC asymmetry in conjunction with septal straightening is essential.
• This approach helps minimize residual or recurrent mid-vault deviation post-surgery.