Vertical Zig-Zag Greenstick Osteotomy: A Novel Technique for Precise Nasal Bone Deformity Correction

Crooked nose deformities remain among the most challenging problems in rhinoplasty due to their combined aesthetic and functional implications. Conventional osteotomy techniques may lead to uncontrolled fractures or postoperative instability. This study aims to evaluate the effectiveness of the newly defined Vertical Zig-Zag Greenstick Osteotomy in correcting C-shaped and reverse C-shaped nasal deformities.

A retrospective study was conducted on 37 patients (25 males, 12 females; mean age, 31.4 years) who underwent rhinoplasty with the Vertical Zig-Zag Greenstick Osteotomy between May 2020 and April 2023. Pre- and postoperative nasal deviation angles were measured using standardized photographs and high-resolution computed tomography (CT) scans at a minimum 12-month follow-up. Nasal bone thickness and length were assessed at three anatomical levels. The percentage of correction toward the ideal nasal axis (180 degrees) was calculated. Statistical comparisons were made using paired t -tests, with significance set at p  < 0.05.

The mean preoperative deviation angle was 144 ± 5.47 degrees in C-shaped and 140 ± 2.64 degrees in reverse C-shaped deformities, improving postoperatively to 175 ± 3.24 degrees and 178 ± 2.20 degrees, respectively ( p  < 0.001). The nasal bone on the deviated side was shorter (28.57 ± 1.34 mm) than the contralateral side (31.61 ± 1.41 mm; p  < 0.001). Surgical outcomes were excellent in 73% and good in 24% of cases, with no complications or revisions.

The Vertical Zig-Zag Greenstick Osteotomy provides a controlled, safe, and reproducible method for correcting crooked nose deformities, maintaining cortical continuity, and improving both aesthetic and functional results without additional osteoplasty.