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

The Pisa Tower Concept, originally described by Finocchi et al, corrects bony vault deviation through asymmetric osteotomies without dorsal reduction. This study evaluates a structural adaptation in which asymmetric osteotomies are integrated into a structural workflow including dorsal hump management and septal reconstruction.

The objective of this study was to assess the effectiveness, safety, and satisfaction of Pisa Tower-style osteotomies as an adjunct to structural rhinoplasty for crooked nose.

A retrospective analysis was conducted on 37 patients undergoing structural rhinoplasty for crooked nose deformity. Osteotomies were adapted from the Pisa Tower model: low-to-low or high-to-low lateral osteotomy on the concave side, wedge resection on the convex side, and transverse or oblique osteotomy depending on deviation origin. All patients underwent endoscopic L-strut septoplasty, dorsal hump removal, and tip support with a septal extension graft. Outcomes included pre- and postoperative CT-based R-Webster angles, nasal axis deviation, a 5-point Likert satisfaction scale, and complications, after a mean follow-up of 18 months (range 12-28).

Mean nasal axis deviation improved from 7.9° ± 1.9° to 1.2° ± 0.6° (P = .0001). R-Webster distance on the convex side decreased from 30.4 ± 4.8 to 23.1 ± 3.9 mm (P = .0003); concave side, from 23.7 ± 3.5 to 22.8 ± 3.3 mm (P = .18). Overall, 89.2% of patients rated satisfaction as 4 or 5. Minor complications occurred in 13.5%; none were major.

In this preliminary report, Pisa Tower-style asymmetric osteotomies may represent a promising adjunct to structural rhinoplasty for the correction of bony nasal deviation, extending Finocchi's concept to a structural framework.

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