A Useful Approach to I-Shaped Crooked Nose Correction: Cross-Spreader Graft Technique

Kavuzlu, Ali; Şahin, Ender

doi:10.1007/s00266-021-02571-2

Cited by 6 publications

(13 citation statements)

References 12 publications

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“…4 Illustration of the S-shaped nose deformity. S-shaped crooked nose is the repetition of this deformity more than once depending on the tip position [12]-causing multiple concave/convex areas with bony pyramid deviations [1] The principles of PR are to respect, conserve or restore the soft tissue envelope ligaments, to minimize the resection of cartilage through reorientation and to keep the dorsal continuity of the patient's own bridge, hence minimizing the ''open roof syndrome'' [7,8]. Although initially described as an endonasal procedure, PR can be performed via open or closed approaches [7].…”

Section: Discussionmentioning

confidence: 99%

“…The S-Shaped Nose Deformity S-shaped crooked nose is the repetition of this deformity more than once depending on the tip position [12]-causing multiple concave/convex areas (Fig. 4) [1]. The S-shaped nose deformity is the least common type within the septal deviation classification [18].…”

Section: The I-shaped Nose Deformitymentioning

confidence: 99%

“…The I-shaped deviation angle is measured as the angle between the vertical line drawn between the mid-point of the upper lip and the glabella mid-point and the line extending from the nasion to the nasal tip, representing the nasal dorsal axis [1] Type 1: Swinging door technique [56] Asymmetric bony wedge resection (''Pisa Tower Concept'') [10,13] Inferior removal of cartilaginous septal striprelease of the pyriform ligament and adjacent upper lateral/nasal junction on the short side of the nose [7] ''Ballerina maneuver'' [17] Excision of the sesamoid cartilages in the scroll area, no reattachment of the ligament on the shorter side [7] S-shaped Anteroposterior S-shape or cephalocaudal S-shape. [19] Concave/convex deformity with bony pyramid deviations Then, complete disarticulation of the cartilaginous septum from the bony septum is performed under video endoscopic vision.…”

Section: The I-shaped Nose Deformitymentioning

confidence: 99%

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A Systematic Analysis of the Nasal Septum in Crooked Noses and Suggested Treatment Algorithm According to Preservation Rhinoplasty (PR) Principles

Tremp

Schneider

Raghu³

et al. 2023

Aesth Plast Surg

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Background A deviated nose is a common problem among patients for both cosmetic and functional reasons. The correction remains a major challenge for the rhinoplasty surgeon. Unrecognized nasal septal deviations stand as the primary reason for failed rhinoplasty outcomes. There is a paucity of data in the literature about septoplasty classifications and technical details in preservation rhinoplasty (PR) for various crooked noses. Materials and Methods The aim of this article is to provide a comprehensive overview of the various septum deviations according to the nasal axis. Moreover, a treatment algorithm is suggested with technical details based on PR principles. Results The directions and curvature of the cartilaginous deviation of crooked nose such as C-shaped, reverse C-shaped, straight axis deviations (I-shaped), and S-shaped are described. According to the deviation, a septoplasty classification (Type 1–Type 4) is suggested. Conclusions On the basis of septal deviation, different PR techniques are proposed to achieve the desired straight nasal dorsum with an optimal functional outcome. Compared to the classical L-strut concept, the quadrangular cartilage remains preserved in the swinging door technique. The cartilage might be further used in the future for grafting in the hybrid structural/preservation technique if needed, ultimately saving rib cartilage and/or conchal cartilage. Finally, surgery time is reduced, and patient’s morbidity remains minimal. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Section: Discussionmentioning

confidence: 99%

Section: The I-shaped Nose Deformitymentioning

confidence: 99%

Section: The I-shaped Nose Deformitymentioning

confidence: 99%

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A Systematic Analysis of the Nasal Septum in Crooked Noses and Suggested Treatment Algorithm According to Preservation Rhinoplasty (PR) Principles

Tremp

Schneider

Raghu³

et al. 2023

Aesth Plast Surg

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“…1,2 How to effectively restore the nasal structure and mechanical balance through surgical treatment is still a difficult problem for clinical surgeons. To date, although various surgical techniques for crooked nose have been reported by numerous experienced surgeons, such as double lateral osteotomy, 3,4 extracorporeal septoplasty, 5 reconstruction, and spreader grafts, 6 there are still cases of postoperative recurrence and unsatisfactory results. In conclusion, the main surgical approaches for crooked nose correction include the open external approach and closed endonasal approach.…”

mentioning

confidence: 99%

The Morphological and Functional Effects of the Endoscope-Assisted One-Stage Approach for Crooked Nose

Sun,

Xie,

Zhen

et al. 2023

Journal of Craniofacial Surgery

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Background: A crooked nose is an external nose deformity predominantly caused by congenital aplasia or acquired secondary to trauma or surgery, often accompanied by a deviated nasal septum. Patients with crooked nose have dual needs to improve both esthetic and functional problems. Methods: The clinical and photographic information of 48 patients diagnosed with a crooked nose and nasal septum deviation treated from January 2018 to January 2022 was acquired. The morphology and functional effects were investigated by evaluating the general condition of the operation, measuring the esthetic indexes of the nose, and subjectively scoring. Results: For both morphology and function, endoscopy-assisted one-stage correction showed positive results in this study. The external nose deviation distance postoperatively measured 1.28 (0.85, 1.97) mm, which significantly decreased from the preoperative value of 3.96 (3.31, 5.29) mm. The scores of doctors and irrelevant medical students on nose morphology increased significantly from 4.75±1.88 and 3.84±0.76 to 6.48±1.21 and 7.21±0.67, respectively. The rhinoplasty outcome evaluation score and the “nasal obstruction symptom evaluation “score of patients were both significantly improved (t = −7.508 and t=6.310, respectively, P < 0.001). Conclusion: Endoscope-assisted one-stage correction of the crooked nose can restore nasal morphology, improve the symptoms of nasal obstruction, and achieve patient satisfaction. It is a minimally invasive, safe, effective, and fast recovery approach for patients who need to solve both esthetic and functional problems.

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“…4 Bilateral spreader grafts were advocated by some authors to support the INV on both sides and to strongly counter the cartilaginous memory of the dorsal part of the cartilaginous nasal septum. [5][6][7] Many modifications have been designed on the spreader grafts to be more effective in the management of the crooked nose deformity, such as the extended spreader graft, 8 the cross-spreader graft, 9 the separated spreader graft "puzzle graft," 10 and the septal crossbar graft. 11 The aim of this study is to evaluate the effect of using a unilateral convex spreader graft in the correction of the C-shaped crooked nose deformity when it is placed against the convex side of the deviated dorsal part of the cartilaginous nasal septum after releasing the other extrinsic and intrinsic forces that are responsible for the nasal deviation.…”

mentioning

confidence: 99%

The Use of a Unilateral Curved Spreader Graft in the Management of Crooked Nose Deformity

Elsayed,

Elbahrawy,

Sorour

et al. 2023

Ann Plast Surg

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Aim of Work The aim of this study is to present a new technique of using spreader grafts in the correction of crooked nose deformity with C-shaped deviation of the middle third of the nose. Patients and Methods This is a prospective case series study conducted on 18 patients with crooked nose deformity with C-shaped deviation of the middle third of the nose. All of the patients were managed by open septorhinoplasty. During surgery, a curved spreader graft was harvested from the nasal septum and placed on the convex side of the C-shaped deviation of the dorsal part of the nasal septum. Objective measurements of the angles of external nasal deviation (END) and the internal nasal valve (INV) angles were performed before and 6 months after the surgery. Subjective assessment of aesthetic satisfaction by the visual analog scale and nasal function by the nasal obstruction symptom evaluation scale was also performed before and 6 months after surgery. Results Eighteen patients were enrolled in the study and completed the minimum follow-up period of 6 months. The mean follow-up period was 17.3 months. Objectively, there was highly significant (P < 0.00001) improvement of the END angle and INV angle. Subjectively, there was also highly significant (P < 0.00001) improvement of both the nasal obstruction symptom evaluation score and the visual analog scale score for aesthetic satisfaction. Conclusions The insertion of a curved unilateral spreader graft over the convexity of the deviated nasal dorsum can correct the END, improve the collapsed INV on both sides, and consequently achieve satisfactory aesthetic and functional outcomes.

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A Useful Approach to I-Shaped Crooked Nose Correction: Cross-Spreader Graft Technique

Cited by 6 publications

References 12 publications

A Systematic Analysis of the Nasal Septum in Crooked Noses and Suggested Treatment Algorithm According to Preservation Rhinoplasty (PR) Principles

A Systematic Analysis of the Nasal Septum in Crooked Noses and Suggested Treatment Algorithm According to Preservation Rhinoplasty (PR) Principles

The Morphological and Functional Effects of the Endoscope-Assisted One-Stage Approach for Crooked Nose

The Use of a Unilateral Curved Spreader Graft in the Management of Crooked Nose Deformity

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