1. 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

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

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

4. Classification of twisted nose(Cont.)

5. Classification of twisted nose
Plastic & Reconstructive Surgery 110: ; 2002

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

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

8. Classification of twisted nose
Arch Otolaryngol Head Neck Surg 134: ; 2008

9. Classification of twisted nose (Cont.)

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

11. 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)

12. 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

13. Classification of Twisted Nose

14. 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.

15. Type I

16. Type II

17. Type III

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

20. 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.

21. Results

22. Results

23. Results

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

28. 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.

29. Osteotome

32. 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

33. Autografts

34. 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

35. 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

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

37. 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.

39. Thank you for your attention