Rhinoplasty in the deviated nose: patterns of recurrence and role of facial asymmetry
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Various hypothesis concerning recurrence of nasal deviation have been proposed in the literature but are not clearly demonstrated.
This retrospective study including 50 consecutive patients with a non-traumatic deviated was conducted to determine the pattern of nasal axis stabilization after rhinoplasty of the deviated nose on the basis of three anthropometric measurements: median face axis (MFA), interpupillary meridian axis (IMA), and scoliosis angle (SA). We studied possible mechanisms associated with progressive re-deviation occurring over time even to a very slight degree in many patients, and we reviewed the mechanisms associated with asymmetry of the face and nose. The hypothesis regarding recurrences and possible modification of surgical procedures are discussed. We retrospectively examined the pattern of recurrence of deviation over time in a consecutive series of non-traumatic patients undergoing primary esthetic or functional rhinoplasty. Patients were followed at 1 week, 2 weeks, 1 month, 3 months, and 1 year.
Of the patients, 92% (46/50) had an asymmetric face after comparing two anthropometric angles: MFA and IMA. Gradual re-deviation occurred in almost every patient, although very slightly, as MFA shifted from 4.1° ± 3.1 preoperatively to 1.0° ± 1.1 at 2 weeks, 1.1° ± 1.5 at 3 months, and 1.7° ± 2 at 1 year. IMA shifted from 4.7° ± 3.3 preoperatively to 0.9° ± 1.7 at 2 weeks, 1.5° ± 1.9 at 3 months, and 1.6° ± 2.8 at 1 year. SA shifted from 171.7° ± 6.2 preoperatively to 179.7° ± 1.4 at 2 weeks, 178.7° ± 3 at 3 months, and 177.8° ± 3 at 1 year. Stabilization was observed after 3 months to 1 year.
Facial asymmetry is present in most patients with a deviated nose. Nasal deviation often recurs, even after adequate surgery. The re-deviation pattern is progressive over the first few months after surgery. Midfacial hypotrophy may play a role in the formation of bony foundation defects of the nose and dynamic and asymmetric soft tissue forces over time. For the “facial envelope theory,” designing a surgical approach that would test this hypothesis is needed.
Level of Evidence: Level III, therapeutic study.
KeywordsCrooked nose Deviated nose Facial asymmetry Outcomes Rhinoplasty
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Ethical approval retrospective studies
Accepted by Belgian ethical committee.
Conflict of interest
Goffart Y., Remacle S. declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
- 3.Boccieri A (2013) The crooked nose. Acta Otorhinolaryngol Ital 33(3):163–168Google Scholar
- 9.Carvalho B, Ballin A, Becker R, Berger C, Hurtado J, Mocellin M (2012) Rhinoplasty and facial asymmetry: analysis of subjective and anthropometric factors in the Caucasian nose. Int Arch Otorhinolaryngol 16(4):445–451Google Scholar
- 14.Scott JH (1954) The growth of the human face. Proc R Soc Med 47(2):91–100Google Scholar
- 15.Baume LJ, Derichsweiler H (1961) Response of condylar growth cartilage to indiced stresses. Science 4:217–223Google Scholar
- 17.Takahashi R (1987) The formation of the nasal septum and the etiology of septal deformity. The concept of evolutionary paradox. Acta Otolaryngol Suppl 443:1–160Google Scholar
- 22.Goffart Y (2010) Morphing in rhinoplasty: predictive accuracy and reasons for use. B-ENT 6(Suppl 15):13–19Google Scholar
- 23.Erdem T, Ozturan O (2008) Objective measurement of the deviated nose and a review of surgical techniques for correction. Rhinology 46:56–61Google Scholar
- 25.Ellis DA, Gilbert RW (1991) Analysis and correction of the crooked nose. J Otolaryngol 20(1):14–18Google Scholar
- 26.Choi JW, Kim MJ, Jeong WS One-piece nasal osteotomy for the correction of a centrally deviated nose [published online 2018 Aug 10]. Aesthetic Plast Surg. https://doi.org/10.1007/s00266-018-1207-x
- 31.Gubish W (1995) The extracorporeal septum plasty: a technique to correct difficult nasal deformities. Palst Reconstr Surg 95(4):672–682Google Scholar