Unilateral Osteotomies for External Bony Deviation of the Nose

Most crooked noses, at the end of a regular rhinoplasty, seem well positioned in the midline. However, several months later, the nasal pyramid may begin its lateral migration and the original deviation, to the chagrin of the surgeon, is partially reproduced. An approach to the externally deviated bony pyramid is reemphasized, involving the performance of one or more osteotomies on only one side of the nose.During the course of a regular rhinoplasty, the bilateral lateral osteotomies displace the lateral nasal walls medially. However, if only a unilateral osteotomy is performed, the nasal dorsum will seem to deviate toward the opposite side. This paper discusses in further detail how to use unilateral osteotomies in the rhinoplasty of an externally deviated nose. Although the unilateral osteotomy technique is not a new concept, it did not receive so far the interest it deserves among surgeons. The unilateral osteotomy technique is an adjunctive solution to a complex problem.