We Performed Rhinoplasty Operation For "Traumatic Nasal Deformity - Crooked Nose"

Treatment of Traumatic Nose Deformity

A patient who had previously suffered a blow to the nose and face during close combat sports, a collapsed and deviated nose, and respiratory distress, applied to our clinic for treatment. After the patient received a blow to the nose from the left diagonal, a C-shaped crooked nose deformity was detected in the nose, accompanied by a collapse of the nasal wing and severe nasal septum deviation. The patient underwent open technique, ultrasonic device and microdrill-assisted septorhinoplasty surgery.

The nose is a distinct feature of the general shape of the face, and problems in the shape of the nose significantly affect facial aesthetics. Traumatic nasal deformities, usually caused by injuries such as accidents, sports blows or physical fights, can lead to a crooked nose, nasal breathing disorders and various psychological problems in patients. Here, I wanted to share with you the before and after images of a nasal reconstruction and rhinoplasty operation performed on an example patient to eliminate both breathing and aesthetic problems.

Diagnosis of Traumatic Nasal Deformity

A correct diagnosis is important to determine the extent of the nasal deformity and plan treatment. Diagnostic steps usually include:

Physical Examination: A comprehensive external and internal evaluation of the nose by a specialist. An endoscopic nasal examination by an ENT specialist with experience in the diagnosis of traumatic nasal deformity is also very important.

Imaging Methods: X-rays or CT scans to identify fractures, deviations, and soft tissue damage.

Functional Assessment: Evaluate nasal airflow and breathing to detect any functional impairment.

Treatment Options for a Crooked Nose

Nonsurgical - Acute - Interventions

In cases where the injury is recent and the deformity is minimal, nonsurgical options such as manual realignment may be effective. This procedure is usually performed within the first two weeks after the injury. You can find detailed information about closed technique nasal fracture reduction on this website. It is usually the process of bringing the nasal bones to their normal old position "as much as possible" under sedation anesthesia or general anesthesia in the early period after the trauma, in the opposite direction of the trauma, with a metal tool and hand manipulation.

Surgical Rhinoplasty

Surgery is usually required for long-term deformities or serious nasal trauma. Septoplasty is usually performed together with the rhinoplasty operation, and stenosis in the nasal wings and airways is also surgically treated at the same time. Therefore, rhinoplasty is planned for both functional and cosmetic purposes. As the definition here

"Functional Rhinoplasty: Focuses on restoring nasal airflow and addressing structural problems such as deviation."

"Cosmetic Rhinoplasty: Primarily aims to improve the aesthetic appearance of the nose." "Combined Rhinoplasty: Addresses both functional and cosmetic concerns at the same time." We perform both of these procedures on our patients, which serve both purposes.

Can Crooked Nose Deformity Be Corrected with Nose Filler?

Only limited cosmetic improvement can be achieved with nasal filler injection, i.e. medical rhinoplasty. Although it is generally not possible to eliminate cosmetic problems with filler injection in crooked nose deformity; in the presence of small amounts of deformity and when patients absolutely do not accept the surgical procedure, nasal filler injection can be planned only for cosmetic and limited shape changes.

In the photo above, the patient's nasal axis is shown with a yellow dashed line before the surgery, and the midline is shown with a red dashed line. The patient's nasal axis is shown in the photo below, where it is in line with the midline after the surgery.

Causes of Traumatic Nasal Deformity

Traumatic nasal deformity can occur for a variety of reasons, including:

Sports Injuries: High-impact sports such as football, basketball, melee combat, and boxing are common causes of nasal trauma and the resulting problems. Although face shields and equipment can be used in these sports nasal injuries, it is not always possible to protect the nose from trauma.

Motor Vehicle Accidents: Various accidents and fatal vehicle injuries that occur during travel can also cause traumatic nasal deformities. Sometimes, just the deployment of in-car airbags can cause serious nasal trauma and nasal deformities.

Falls: Accidental falls can cause serious nasal deformities, especially in children and the elderly, and in patients with dizziness.

Physical Fights: During fights, force applied harshly to the face and nose can often lead to a crooked or broken nose. Serious injuries to other facial bones can also occur.

Other Traumas: Workplace accidents and other unexpected occupational events can also cause nose-face injuries.

Common Symptoms of a Crooked Nose

Traumatic nasal deformity can usually occur with aesthetic and functional symptoms such as the following:

Visible Deformity: Noticeable bending or displacement of the nasal structure. As in the patient I shared here, the nasal wall can completely collapse, the septum inside the nose can shift or displace at the same time, and the nasal wings can collapse. These deformities can occur depending on the severity of the trauma and the area it comes from in the nose.

Breathing Difficulties: Obstruction of the nasal airways can occur due to a crooked septum, collapse of the nasal wings or nasal tip deformities.

Pain and Swelling: Constant pain or swelling can occur in the nose and surrounding areas. These abnormalities can be more pronounced in patients with displaced nasal fractures.

Nasal Congestion: Chronic nasal congestion that does not improve with medication can occur. This condition in patients may occur not only due to the shape change in the nasal bones; but also due to nasal septum deviation and collapse of the nasal wings.

Frequent Nosebleeds: Damage to the nasal tissues may lead to recurrent bleeding. This condition is more evident especially when severe traumatic septum deviation occurs, causing contact between the nasal septum and the lateral nasal wall, and in patients with serious vascular networks in the nasal septum mucosa.

Self-confidence Issues - Psychological Problems: A crooked nose can affect self-confidence and emotional well-being. It can cause serious psychological effects in patients.

Risks and Complications of Crooked Nose Aesthetic

Be aware of the following potential risks and complications associated with rhinoplasty for traumatic crooked nose deformities. Patients with crooked nose deformities often have deformities in more than one area of ​​the nose. While rhinoplasty is generally safe, it is important to be aware of the potential risks:

• Infection
• Bleeding
• Scarring
• Permanent swelling
• Unsatisfactory results requiring revision surgery

Link where you can find articles prepared by Dr. Murat Enöz about "Traumatic Nasal Deformity" on this website (you can click on "more posts" at the end of the page in the opened link) >> https://www.ent-istanbul.com/search?q=traumatic+nose+deformity 

Source links >> The crooked nose - PMC / Crooked nose: An update of management strategies - ScienceDirect

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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