[Analysis of facial asymmetry in patients with crooked noses]. / Analyse von Gesichtsasymmetrien bei Patienten mit Schiefnasen.

BACKGROUND: Surgical management of crooked nose is challenging even for experienced rhino surgeons, although numerous techniques for correction have been described. Not infrequently, there is a facial asymmetry in addition to the crooked nose influencing the aesthetic results of the operation. Therefore, the purpose of this study was to determine how often there is an asymmetry of the face in addition to a crooked nose. MATERIAL AND METHODS: Retrospectively the data of 607 patients with a crooked nose (304 women, 303 men, mean age 30 years) were evaluated. The preoperative photos of the face were anthrometrically assessed based on angle measurements. RESULTS: 382 of the 607 patients had a c-shaped (63 %) and 225 an i-shaped (37 %) crooked nose. More than three-quarters of the patients had facial asymmetry in respect to the connecting line of the pupils and nasal base line. 49 % of patients reported a history of nasal trauma, but this had no relevant influence on the frequency of facial asymmetry. CONCLUSIONS: Pre-existing facial asymmetry is very common in patients with crooked nose and can significantly affect the aesthetic outcome of nasal surgery. This should be addressed as part of the informed consent. In particular, it should be mentioned that the surgical outcome can remain below the patient's aesthetic expectations. Not rarely, a revision surgery may be necessary.

Anthropometric Evaluation of Photographic Images Before and After Functional Nasal Surgery in Patients With Deviated Noses.

BACKGROUND: Numerous techniques for correction of deviated noses have been described. Nevertheless, surgical management is challenging even for experienced rhinosurgeons. Often, a "residual deformity" after functional septorhinoplasty (SRP) due to a deviated pyramid syndrome may remain. OBJECTIVE: Therefore, the purpose of this study was to determine how frequent functional SRP in patients with a deviated nose results in "successful" straightening of the external nose based on standardized angle measurements. Possible influences having a positive or negative effect on the surgical success were identified. METHODS: Photo documentation of 607 patients with deviated noses (304 women, 303 men, median age 30 years) before and after nasal surgery were retrospectively analyzed using standardized angle measurements. The pre- and postoperative photos of the faces were anthropometrically measured. The median follow-up was 6 months. RESULTS: A "straight" deviated nose (I-type) was present in 225 patients (37%), a C-shaped nose (C-type) in 382 patients (63%). More than 75% of the patients presented a facial asymmetry. Based on angle measurements alone, a total of 452 (75%) noses were straightened or postoperatively improved. 155 noses (25%) still showed a biometric deviation. The I- or C-type had no relevant influence on outcome. CONCLUSION: A purely biometric analysis of crooked noses is difficult and its importance is limited due to commonly pre-existing facial asymmetries. The risk of a "residual deviation" after rhinoplasty in patients with deviated noses must not be underestimated. This fact should be addressed as part of the informed consent. In particular, it should be mentioned that the surgical outcome can remain well below the patient's aesthetic expectations. Not rarely, a revision surgery may be necessary.