Management of the scoliotic nose

The twisted nose represents an enigma to many rhinoplasty surgeons because of its frequent recurrence following correction. Reasons for failure include improper preoperative evaluation, failure to understand and compensate for the dynamics of cartilage and faulty surgical execution. One cannot expect a perfectly straight nose on all occasions but an analytic evaluation and appropriate surgical execution can routinely yield an apparently straight nose. The dynamics of the twisted nose are explored with special emphasis on the septal contribution to the scoliosis. The contribution of the bony and cartilaginous structures to the deformity is emphasized. An appreciation of the nasal cartilage-osseous unit is essential to understand the production of the twisted nose and its subsequent correction.