Correction of Twisted Nose 台灣耳鼻喉頭頸外科醫學會105屆學術演講會 三軍總醫院耳鼻喉頭頸外科部 鄭立享 醫師 中華民國107年11月04日

Introduction Understanding of nasal anatomy & physiology Accurate preoperative analysis & intraoperative diagnosis Precisely execute the surgical steps Optimize both functional and aesthetic outcomes

Classification of twisted nose (1) at the nasion (2) at the rhinion (3) combinations of the two. The Journal of Otolaryngology 20:1, 1991

Classification of twisted nose(Cont.)

Classification of twisted nose Plastic & Reconstructive Surgery 110:1509-23; 2002

Classification of twisted nose(Cont.) Plastic & Reconstructive Surgery 110:1509-23; 2002

Classification of twisted nose (Cont.) Plastic & Reconstructive Surgery 110:1509-23; 2002

Classification of twisted nose Arch Otolaryngol Head Neck Surg 134:311-315; 2008

Classification of twisted nose (Cont.)

A new simple classification Total 384 cases (M:314, F:70), mean age: 27 Followed for 6 months to 71 months ( mean 21 months)

Patients (%) Gender Male 314 (82) Female 70 (18) Age 15-19 24 (6) 20-29 251(65) 30-39 68 (18) 40-49 34 (9) 50-59 7 (2) Surgical indications Twisted nose 308 (80) Twisted and saddle nose 60 (16) Twisted and short nose 16 (4)

Classification of Twisted Nose Type I : lower two thirds of nose Type II : whole nose with same direction Type III : whole nose with curved rhinion a: C-shaped b: reversed C-shaped

Classification of Twisted Nose

Type I is only deviated septal axis without deviated bony vault, and deviation can be linear, C-shaped, or S-shaped. Type II and Type III is combined septal deformity and bony pyramid deformity.

Type I

Type II

Type III

Surgical Procedures Septoplasty or Osteotomy & Septoplasty Tip plasty Closure and Fixation

Material & Method Self-evaluation survey regarding satisfaction with nasal function and aesthetics Preoperative and postoperative photography to judge objectively the aesthetic outcomes of the surgery.

Results

Results

Results

Results Two patients with residual deviation of dorsum objectively who were satisfied the results after revision rhinoplasty.

Discussion Medial osteotomies are necessary to free the nasal bones from the perpendicular plate of the ethmoid. Lateral osteotomies are performed by high-low-high, low curved pathway. Intermediate osteotomy usually was not necessary.

Osteotome

Discussion a 12-mm (at least) L-shaped septal strut should be preserved to maintain the structure Deformities of the cartilaginous dorsum are corrected by scoring along the concave surface of the septum

Autografts

Types of grafts Spreader graft 384 Columellar strut 246 Grafts Number Onlay graft 54 Tip-shield graft 65 Splinting graft 16 Buttress graft 32 Caudal extension graft 38 Lateral crural graft 33 Plumping graft 10

Discussion Spreader graft straightening deviated septum recreating the esthetic dorsal lines restoring and maintaining the internal valve. 10 to 20 mm in length, 2 to 3 mm in thickness , and 3 to 4 mm in height

Discussion Tip plasty caudal extension graft shield graft buttress graft lateral crural strut

Conclusion This classification and surgical algorithm is simple and reproducible . With an open approach, osteotomy, septoplasty, tip plasty, and dorsal augmentation can be performed precisely.

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