title: A Combined Approach To Crooked Nose Deformity.
abstract: BACKGROUND
  Crooked nose deformity is a complex anatomical deformity; therefore, repair remains a challenge. Here, we introduce a new technique for crooked nose deformity repair.
  
  
  METHODS
  Twenty-two patients underwent intraoperative evaluations and measurements, followed by surgery using the open rhinoplasty technique. Our method involves three major steps. First is the creation of an asymmetric medial oblique osteotomy using piezoelectric ultrasonic surgery and double lateral osteotomies, wherein the asymmetric bony ascending part of the maxillary bone at the base of the nasal vault is fractured, pushed in, and delivered to the face. Second is septoplasty with L-strut preservation. The L-strut is removed as a 1-cm block caudally from the septal stump of the keystone area. A (or double) fabricated batten cartilage graft is placed on the concave side of the deviation and sutured to cover the septal stump. The L-strut is then replaced and sutured on the batten graft, redirecting the septum toward the midline. Third is an overlapping cruroplasty on the side of the long asymmetrical lower lateral cartilage to equalize both wings and correct tip deviation.
  
  
  RESULTS
  Our new technique was effective for the treatment of crooked nose deformity.
  
  
  CONCLUSIONS
  Our technique of K-stone batten plasty with delivery to the face and overlapping cruroplasty may be an effective surgical method for crooked nose deformity.
  
  
  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: Otorhinolaryngology Head&Neck Surgery Department, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mahallesi, Mimar Sinan Caddesi No: 41, Pendik, Istanbul, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Inanli
authors.affiliation: Otorhinolaryngology Head&Neck Surgery Department, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mahallesi, Mimar Sinan Caddesi No: 41, Pendik, Istanbul, Turkey. adembinnet@hotmail.com.
authors.forename: Adem
authors.identifier: http://orcid.org/0000-0002-2797-0248
authors.initials: A
authors.lastname: Binnetoglu
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055171:Nasal Cartilages / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery; D009666:Nose / Q000002:abnormalities*; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D012225:Rhinoplasty / Q000379:methods*; D018570:Risk Assessment; D013524:Surgical Flaps / Q000637:transplantation*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Crooked nose; Extracorporeal septoplasty; Rhinoplasty; Twisted nose