The deviated nose and rhinoplasty

In sailing terms the septum is the rudder of the nose!

Often a crooked nose is secondary to deviation of the septum. These deviations of the septum occur after trauma or nasal surgery or during the growth phase of the nose. Childhood injuries can lead to the occurrence of septal deviation in adolescence. It may also be caused by asymmetric development of the facial bones and by unilateral partial or complete facial paralysis. Cleft lip and cleft palate will also cause deviation and deformity of the nasal septum.

Whilst one of the aims of rhinoplasty is to straighten the nose… the recurrence of septal deviation is reported as high as 30% following rhinoplasty (nose job). I believe this is the result of techniques that rely on septal cartilage scoring as a sole means of straightening the deviation. While scoring appears to correct the deviation at the time of surgery, the weakened (scored) cartilage is prone to relapse.

I believe the deforming forces must be fully released and the deviated septum strengthened by adding septal cartilage grafts. With this technique the recurrence with these techniques is less than 5%.

Alternative procedures camouflage a deviation by using ear or septal cartilage grafts to hide the deviation, this is a compromised approach but suitable when deviations are minor and breathing satisfactory.

(Byrd HS, Salomon J, Flood J: Correction of the crooked nose. Plast Reconstr Surg 1998 102(6):2148)