Armando Boccieri - Gobba Nasale
CROOKED NOSE
CROOKED NOSE

The crooked nose presents deviation of the nasal pyramid from the median line in such a way as to be vaguely C-shaped or S-shaped in appearance or totally displaced to one side.

                        

                        C-shaped deviation          S-shaped deviation        Linear deviation

There is always impaired nasal respiration together with a major aesthetic blemish that cannot be hidden due to its position. The therapeutic problem is complex not only because serious asymmetry can make any solution difficult but also due to the risk in all cases of the defect reappearing to varied degrees over time after the operation. This is due to the precisely to the elasticity of the cartilaginous structures of the nasal pyramid involved, which thus retain a “memory” of the deviation and tend to return to their original position over time.

Considerable progress toward solution of this problem came with the use of spreader grafts taken from the septum and sutured in the dorsal portion, which are able in virtue of their shape to counteract the cartilaginous memory of the deviation. 

Schematic diagram of the spreader graft technique used in the case of deviation of the nasal pyramid. The straight graft (shown in red) is secured to one side of the dorsal nasal septum in order to act as a splint for the deviated cartilage. The effect proves lasting. 


In 2003 I myself devised an innovative technique for treatment of the crooked nose by means of a septal crossbar graft, whereby a rectangular portion of cartilage is fitted into the dorsal septum just as a bar can be placed behind a door to prevent opening from the outside.  

 

Schematic diagram of the septal crossbar graft technique. A graft harvested from the basal portion of the cartilaginous septum and fitted into the dorsal septum on the concave side is capable of effecting a lasting correction of most serious deviations of the nasal pyramid (Boccieri 2003).

 

Since its publication in an illustrious American scientific journal, this technique has enjoyed great success all over the world and is now used by many plastic surgeons in all the continents. Major international acknowledgment of my technique came with its inclusion in the 2004 American Yearbook of Plastic Surgery as one of nineteen techniques of nasal surgery from all over the world selected by the organization for their outstanding scientific importance.

 

 
CORRECTING A CROOKED NOSE AND OTHER FLAWS

Having waited anxiously until he stopped growing and was no longer a minor, this young patient was finally able to correct these major aesthetic and functional defects, which also caused no small number of difficulties in interpersonal relationships.

Preoperative analysis reveals serious linear deviation of the nasal pyramid to the right, a large osteocartilaginous hump and a drooping nasal tip.

Rhinoplasty executed by means of open access. The hump was removed and reshaping carried out with upward rotation of the nasal tip. Central repositioning of the nasal pyramid was obtained by means of a spreader graft on the right side of the dorsal septum.

It is interesting to note that in addition to the postoperative aesthetic improvement, the expression of the face is greatly changed and clearly reflects the patient’s greater self-confidence.

 
A MARKEDLY CROOKED NOSE SINCE CHILDHOOD

Affected since childhood by serious C-shaped deviation of the nasal pyramid that resulted in psychological complexes, this young patient hesitated to have an operation because she did not believe that it would make her nose completely straight.

 
Preoperative analysis reveals major deviation of over 1 cm of the nasal dorsum from the median line with the presence of a small hump in profile. The deviation was corrected by means of a septal crossbar graft, a technique of my own invention used to treat the most serious cases of deviation of the nasal pyramid.
The profile was improved with a slight straightening of the nasal dorsum, thus making the face more attractive while leaving the aesthetic result as natural as possible in appearance.

This case was published in the article of 2003 in which I first described the innovative surgical technique of the septal crossbar graft, my own invention, to treat the most serious cases of crooked nose: ‘Septal Crossbar Graft for the Correction of the Crooked Nose,’ Plastic and Reconstructive Surgery, February 2003, 111(2), pp. 629–38.

 
A CROOKED NOSE NOT CORRECTED BY PREVIOUS SURGERY

This patient was bitterly disappointed after undergoing an operation about a year earlier that failed to give the desired result, as his nose remained crooked.

       
     

Analysis revealed a major C-shaped deviation of the axis of the nasal pyramid from the median axis of the face that was particularly evident in the lower section. The defect was corrected by means of a septal crossbar graft, a technique that I invented and use also in cases of secondary rhinoplasty.

 
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