Aesth. Plast. Surg. 30:686688, 2006 DOI: 10.

1007/s00266-006-0023-x

Innovative Techniques

A Simple Technique for Correcting the Hump on a Deviated Nose

Jin Kook Kim, M.D., Ph.D.,1 Jin-Soo Lee, M.D.,2 Heung-Man Lee, M.D., Ph.D.,3 and Jae Hoon Cho, M.D., Ph.D.3
1 2

Department of Otorhinolaryngology, Head and Neck Surgery, College of Medicine, Kon-Kuk University, Seoul, Korea Faceline Clinic, Seoul, Korea 3 Department of Otorhinolaryngology, Head and Neck Surgery, College of Medicine, Korea University, Seoul, Korea

Abstract. The traditional technique for correcting the hump on a deviated nose frequently results in redeviation. The main cause of redeviation is incomplete correction of the septal deviation, but complete septal correction is very dicult. The authors have therefore adopted a new technique to reduce the possibility of redeviation. The new technique is simple. It no longer requires complete septal correction and gives good results. Key words: Deviated noseHumpNew technique Fig. 1. (A) The hump is removed in a beveled manner to equalize the lateral walls. (B) After septoplasty and osteotomy, the dorsum of the nose is realigned with the midsagittal plane.

Correction of a deviated nose remains one of the most challenging problems in septorhinoplasty. The traditional technique for correcting the hump on a deviated nose involves resection of the hump in a beveled manner to equalize the lateral walls (Fig. 1A), followed by septoplasty and lateral osteotomy, and nally realignment of the nasal dorsum with the midsagittal plane of the face (Fig. 1B) [1,4]. In our experience, redeviation frequently results from correction using this technique, but few studies concerning redeviation have been reported. Redeviation is thought to be caused by many factors. The main cause is believed to be residual septal deviation because complete correction of the septal deviation is very dicult despite the use of varied surgical techniques [2]. We have therefore adopted a

new technique that does not require complete septal correction to correct the deviated nose and reduces the probability of redeviation.

Methods We operated on 23 patients at BunDang Military Hospital. All were male soldiers with a mean age of 26.1 years. Correction was performed with the patients under general anesthesia using the open approach for accurate visualization. After elevation of the ap, the deformity was evaluated and the hump resected. With the new procedure, resection is performed mainly on the deviated side in an oblique manner (Fig. 2A) so that the deviation is corrected without realignment by septoplasty and osteotomy. Medial and lateral osteotomy then is performed to close the open roof and reduce the width of the nose (Fig. 2B). Rasping is performed for rened correction, and septoplasty is carried out to correct caudal septal

Correspondence to J. H. Cho, M.D., Ph.D.; Department of Otorhinolaryngology, Head and Neck Surgery, Ansan Korea University Hospital, 516 Gojan 1 Dong, Danwon-Gu, Ansan-Si, Kyunggi-Do, Korea; email: chojaehoonent@ daum.net

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Fig. 2. (A) The hump is removed mainly on the deviated side in an oblique manner. (B) Osteotomy is performed to close the open roof.

Fig. 4. Preoperative (left) and 8-month postoperative (right) view. The hump of a C-type deviated nose was corrected by this technique, and dorsal augmentation with Gore-Tex was added.

Fig. 3. Preoperative (left) and 9-month postoperative (right) view. The hump of a C-type deviated nose was corrected using this technique and cap graft was added.

deviation and obtain graft material for the L-strut, the tip graft, and so forth. Further procedures such as tip surgery and augmentation are undertaken as necessary. A cap graft using 6- to 8-mm-wide septal cartilage is adopted mainly for tip surgery (Fig. 3) and Gore-Tex for augmentation (Fig. 4). After completion of the surgery, we apply bilateral intranasal packing for 2 days and a splint for 1 week. The minimal follow-up period after surgery has been 5 months.

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Technique for Correcting a Nasal Hump

unexpectedly after complete surgical correction. Okur et al. [3] reported that 46% of C-shaped deviated noses were corrected by less than 70% of the deviated angle of the nose before surgery. Among many factors, incomplete septal correction is thought to be the main cause of redeviation. The recoiling force of an incompletely corrected septum causes a nose that was completely corrected during operation to redeviate as time passes [2]. However, it is hard to achieve complete septal correction, especially in cases of large or posterior bony septal deviations. The traditional technique for a deviated nose is based on the assumption that the septum can be corrected perfectly. As a result, redeviation frequently occurs. We now accept the fact that complete correction of the septum is dicult and remove the deviated portion without correcting the septum. With the previous technique, the hump was removed in anticipation of the corrected status to follow from septoplasty and osteotomy, whereas with the new technique, hump reduction can be performed more easily and intuitively [1,4]. The best feature of the new technique is the absence of recurrence after surgery. We have operated on 23 patients with this technique, and none of them has experienced subsequent redeviation (Figs. 3, 4, and 5). We use medial and lateral osteotomy not to correct the deviation, but to close the open roof and reduce the width of the nose. Septoplasty is performed mainly on the anterior portion to obtain cartilage for the graft and to relieve nasal obstruction. This technique is most suitable for mild to moderate C-type deviation, and has limitations when used for severe or I-type deviations. In conclusion, the new technique we describe permits the hump of a deviated nose to be corrected without danger of redeviation. References
1. Gunter JP, Rohrich RJ, Adams WP: Dallas Rhinoplasty: Nasal surgery by the masters. Quality Medical Publishing: St. Louis, p. 803, 2002 2. Hossam MT, Foda MD: The role of septal surgery in management of the deviated nose. Plast Reconstr Surg 115:406415, 2005 3. Okur E, Yildirim I, Aydogan B, Akif Kilic M: Outcome of surgery for crooked nose: An objective method of evaluation. Aesth Plast Surg 28:203207, 2004 4. Rees TD, LaTrenta GS: Aesthetic plastic surgery. 2nd ed. WB Saunders co: Philadelphia, p 318, 1995

Fig. 5. Preoperative (left) and 6-month postoperative (right) view. The hump of a mild C-type deviated nose was corrected by this technique.

Discussion Redeviation after corrective surgery for a deviated nose causes the surgeon embarrassment. This problem is very dicult to predict because it occurs