Correction of Crooked Nose in Preservation Rhinoplasty with Asymmetric Let-Down Osteotomy

Correction of nasal axis deviation in rhinoplasty is challenging. In literature most effective treatments include osteotomies and use of asymmetrical spreader graft or flaps with aim of pushing axis into midline. But despite best efforts, recurring and/or residual deviations are very common.

Preservation rhinoplasty reemerged in late 2010s. Among the perks of this technique lies an innate capability to correct severe axis deviations very effectively and yet easily.

A prospective, randomized, blinded study is planned. 64 patients with severe nasal axis deviations are enrolled in study and randomly assigned to control and experiment groups (n=32). Experiment group underwent nasal axis deviation correction with asymmetrical let-down technique and control group a conventional structural rhinoplasty with dorsal reconstruction using spreader flap & grafts. Data is extracted from pre- and post-operative photographs, operative notes and patient files, assessed the effectivity of asymmetric bone impaction and compared it between groups.

An analysis of data showed 90±5.67% correction in the axis deviation on 12th month with use of asymmetrical bone impaction. Comparison of 1st and 12th month results showed no statistically significant recurrence (p>0.05). A statistical analysis comparing groups showed significantly better correction of nasal axis deviations in study group (p<0.01*).

In the light of data emerged from this study we report successful employment of asymmetric bone impaction in correction of crooked noses, adding to the armamentarium of surgeons as a viable alternative for the correction of axis deviations in crooked noses.