Often nasal deviation happens with injury rather than conjenital reason. If deviation is only on nose it could be come from injury
but if philltrum, lips and chin are also deviated, it also cause deviation of nose
Reason why deviated nose correction is most difficult surgery in rhinoplasty
01.There are many tissues related with nasal deviation.
02.Function and look of the nose must be considered too
03.There is tendency of tissue memory.
Principle of deviated nose correction
01.If it is not severe it is better to do camouflage graft on depressed area rather than fixing fundamental reason
02.If patients looking for fundamental correction, through correction is required
03.Form and function of nose need to be considered.
04.There is tendency of tissue memory, covercorrection is more recommended
05.Follow up is more important.
Correction of cause of deviation is the principle but if there is not functional difficulty it is best to do tissue graft(cartilage, fascia, fat, dermis)
to correct the form of nose without complicated operaton. Following is the basic correction method
01.Deviated nose : Osteotomy is used for correction. In severe correction double osteotomy is required.
02.Upper lateral cartilage : Spread graft and asymmetric rotational suture
03.Nasal tip cartilage : Spread graft, septal spread graft
04.Septal cartailage : Septoplasty, Septal spread graft. In case of severely deformed septal cartilage total spetal reconstruction is recommend which is removing all septal cartilage and insert it again.
05.Skin or soft tissue : Skin removal and tissue graft. The most important thing is finding part of deviation on the nose