Recent or old trauma to the nose can cause a fractured nose, a non-displaced nasal fracture, or a dislocation of the upper lateral cartilage off of the pre-existing nasal bones. In addition, a deviated septum can result from a fracture of the nasal septum, which can then block airflow. It’s very important to evaluate the septum for airflow issues after trauma to the nose.
There are many issues in the nose that can create a crooked nose. An asymmetric nose can be created from crooked nasal bones, asymmetric (concave and convex) upper lateral cartilages in the mid-portion of the nose, and crooked nasal tip cartilages. In addition, the caudal septum can be crooked which creates asymmetrical nostrils. Each one of these issues is dealt with differently during a closed rhinoplasty approach to straighten the nose.
William Portuese, M.D.
William Portuese, M.D. prefers to perform these procedures with a closed rhinoplasty approach under general anesthesia as an outpatient surgical procedure. To straighten crooked nasal bones requires medial and lateral osteotomies placed in them and manually reducing the fracture and twisted nasal bones to make them straight, symmetrical and parallel. A cast is applied across the bridge of the nose and is left in place for one week. Visible bruising and swelling also takes place for approximately 10 days. The majority of the bruising and swelling is due to the osteotomy placement in the nasal bones.
To straighten the mid-portion of the nose depends upon what the issues are regarding the upper lateral cartilages. A concave upper lateral cartilage is bolstered outward with a cartilaginous spreader graft harvested from inside the nose. Spreader grafts prevent the upper lateral cartilage from becoming concave and herniating downward and inward, which creates a crooked appearance. A convex upper lateral cartilage is simply shaved down in order to make it balance with the opposite side. When the nasal tip cartilages are asymmetric, a cartilage graft can be placed on the weak side, or cartilage shaved down on the high side of the nasal tip. Significant asymmetry of the nasal tip cartilage requires suture techniques applied to them with a full delivery to identify the pre-existing asymmetries.
When looking at the base view of the nose, the nostrils can also be asymmetrical due to a variety of issues. If the nostrils themselves are asymmetrical, an alar-plasty on one side can try to match the wider nostril to make it look like the narrower one. Many times, a crooked columella is due to a caudal septal deviation, which can be trimmed back or straightened. Dr. Portuese is the medical director of the The Seattle Facial Plastic Surgery Center