Hump Nose and Coexisting Deviation in Rhinoplasty: Their Association and Surgical Considerations

Background/Objectives: Dorsal humps and nasal deviation are common deformities in rhinoplasty. While existing classification systems characterize these deformities individually, their concurrent presentation complicates surgical planning. The aim of this study was to examine the association between dorsal humps and nasal deviation in rhinoplasty patients and assess their influence on surgical decision-making. Methods: This retrospective study analyzed 90 consecutive patients who underwent primary rhinoplasty between January 2020 and December 2023. Dorsal humps were classified as isolated or generalized. Nasal deviation was initially categorized into five types, then regrouped by bony involvement: bony deviation versus cartilaginous only deviation. The association between humps and deviations was examined, and their impact on surgical techniques was analyzed. Results: Dorsal humps were present in 64 (71%) and deviations in 63 (70%) patients. A significant association was observed between hump presence and deviation (p < 0.001); 83% of patients with humps exhibited concurrent deviation compared to 39% in those without humps. Patients with deviations showed 7.7-fold increased odds of having a concurrent hump (p < 0.001). Bony deviation demonstrated a particularly strong association with hump presence (OR 14, p < 0.001), while cartilaginous only deviation showed no significant association. Binary logistic regression identified deviation presence as the primary predictor for requirements of both osteotomy (OR 3.5, p = 0.025) and camouflage (OR 4.4, p = 0.025). Conclusions: Dorsal humps and nasal deviation frequently coexist, particularly humps with bony deviations. Surgical decision-making is more strongly influenced by deviation status than by hump presence. An integrated classification system incorporating both characteristics is needed to optimize surgical planning.