title: Straight septum, crooked nose: an overlooked concept.
abstract: BACKGROUND
  Asymmetric facial skeletal growth is a common finding in the rhinoplasty patient population. This common abnormality affects all facial components, including the upper lateral cartilages (ULCs). The asymmetric growth also may produce uneven thickness, consistency, curvature, and elastic recoil of the ULC. Ignoring this asymmetry may have a marked impact on the outcome of any rhinoplasty operation, especially in the management of crooked noses.
  
  
  METHODS
  The files of 89 consecutive rhinoplasty patients who underwent surgery by a single surgeon were reviewed for deformities of the middle vault and to tabulate the procedures performed in each individual case.
  
  
  RESULTS
  Of the 89 rhinoplasty cases, 72 (81 %) had asymmetric ULCs. Approximately 30 % (27/89) of the cases had a straight septum with asymmetric ULCs which required appropriate correction.
  
  
  CONCLUSIONS
  Awareness of an asymmetric ULC in a crooked nose and an attempt to correct this condition in addition to straightening of the septum is key to decreasing postoperative residual or recurrent mid-vault deviation.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Burn Research Center, St. Fatima Hospital, Tehran University of Medical Sciences, 172 Zafar St., Suit 9, Tehran, Iran. info@drhafezi.com.
authors.forename: Farhad
authors.initials: F
authors.lastname: Hafezi
authors.affiliation: Loghman Hakim Hospital, Shahid Beheshty University of Medical Sciences, Tehran, Iran.
authors.forename: Bijan
authors.initials: B
authors.lastname: Naghibzadeh
authors.affiliation: St. Fatima Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Abbas Kazemi
authors.initials: AK
authors.lastname: Ashtiani
authors.affiliation: Department of Plastic Surgery, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Bahman
authors.initials: B
authors.lastname: Guyuron
authors.affiliation: Kowsar Laboratory, Tehran, Iran.
authors.forename: Amir Hossein
authors.initials: AH
authors.lastname: Nouhi
authors.affiliation: Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ghazal
authors.initials: G
authors.lastname: Naghibzadeh
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D055171:Nasal Cartilages / Q000002:abnormalities* / Q000601:surgery*; D009300:Nasal Septum; D012225:Rhinoplasty; D055815:Young Adult