Asymmetric Osteotomies in Structural Rhinoplasty: A Pisa Tower-Inspired Approach for Crooked Noses.

Area of Science:

• Plastic Surgery
• Otolaryngology
• Facial Plastic Surgery

Background:

• The Pisa Tower Concept utilizes asymmetric osteotomies for bony vault deviation correction without dorsal reduction.
• This study integrates asymmetric osteotomies into a comprehensive structural rhinoplasty workflow.

Purpose of the Study:

• To evaluate the effectiveness, safety, and patient satisfaction of Pisa Tower-style osteotomies.
• To assess their utility as an adjunct to structural rhinoplasty for crooked nose deformities.

Main Methods:

• Retrospective analysis of 37 patients with crooked nose deformity undergoing structural rhinoplasty.
• Adaptation of Pisa Tower osteotomies combined with endoscopic septoplasty, dorsal hump management, and tip support.
• Outcomes measured by CT-based R-Webster angles, nasal axis deviation, patient satisfaction, and complication rates.

Main Results:

• Significant improvement in mean nasal axis deviation (7.9° to 1.2°, P=.0001).
• Reduction in R-Webster distance on the convex side (30.4mm to 23.1mm, P=.0003).
• High patient satisfaction (89.2% rated 4 or 5), with minor complications in 13.5%.

Conclusions:

• Pisa Tower-style asymmetric osteotomies are a potentially valuable addition to structural rhinoplasty.
• This technique effectively addresses bony nasal deviation within a broader surgical framework.
• The method shows promise for improving outcomes in crooked nose correction.