A Systematic Analysis of the Nasal Septum in Crooked Noses and Suggested Treatment Algorithm According to Preservation Rhinoplasty (PR) Principles

Tremp M, Schneider J, Raghu RBN, Goksel A, Saban Y.

PubMed 36826521 Publisher (DOI)Free full text (PMC)

What this paper says

The authors classify the ways a septum bends in a crooked nose into four types and propose a matching preservation rhinoplasty technique for each.

Overview

A deviated nose is a common complaint for both appearance and breathing, and correcting it remains difficult. The abstract states that unrecognized septal deviations are the leading reason rhinoplasty fails, and that little has been published on septoplasty classification within preservation rhinoplasty. This article maps septal deviations by their direction relative to the nasal axis and proposes a treatment algorithm built on preservation principles.

Sections of note

Article type: anatomical overview plus proposed treatment algorithm. Level of evidence III as assigned by the journal.
Cartilaginous deviations are described by shape: C-shaped, reverse C-shaped, straight axis or I-shaped, and S-shaped.
A septoplasty classification of Type 1 through Type 4 is proposed, keyed to the deviation pattern.
In the swinging door technique the quadrangular cartilage is preserved, unlike the classical L strut approach which removes more of it.
Claimed advantages: preserved cartilage remains available for later grafting, potentially sparing rib or ear cartilage, plus reduced operating time and minimal morbidity.
No patient numbers, outcome measures, complication rates or follow up data appear in the abstract.

What it means for a patient

A crooked nose usually cannot be straightened without addressing the septum, the internal partition, which is often the structure causing the lean.
Preserving rather than removing septal cartilage keeps material available if a future operation is needed.
The claims of shorter surgery and less morbidity are stated, not measured. The abstract reports no data supporting them.
Limits: this is a proposed classification and algorithm with no outcome series attached.

Why this paper matters

Preservation rhinoplasty grew from techniques for the bridge, and its handling of the septum has lagged behind. A classification that tells a surgeon which preservation maneuver fits which deviation fills that gap on paper. Whether following the algorithm actually straightens noses more reliably than conventional septoplasty is untested here.

Terms

Nasal septum: the wall of cartilage and bone dividing the two sides of the nose.
Crooked or deviated nose: a nose whose axis leans off the facial midline.
L strut: the L shaped strip of septal cartilage left to support the nose after septoplasty.
Quadrangular cartilage: the main four sided plate of cartilage forming the front septum.
Swinging door technique: freeing the septal cartilage and repositioning it on the midline rather than excising it.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Background: A deviated nose is a common problem among patients for both cosmetic and functional reasons. The correction remains a major challenge for the rhinoplasty surgeon. Unrecognized nasal septal deviations stand as the primary reason for failed rhinoplasty outcomes. There is a paucity of data in the literature about septoplasty classifications and technical details in preservation rhinoplasty (PR) for various crooked noses.

Materials And Methods: The aim of this article is to provide a comprehensive overview of the various septum deviations according to the nasal axis. Moreover, a treatment algorithm is suggested with technical details based on PR principles.

Results: The directions and curvature of the cartilaginous deviation of crooked nose such as C-shaped, reverse C-shaped, straight axis deviations (I-shaped), and S-shaped are described. According to the deviation, a septoplasty classification (Type 1-Type 4) is suggested.

Conclusions: On the basis of septal deviation, different PR techniques are proposed to achieve the desired straight nasal dorsum with an optimal functional outcome. Compared to the classical L-strut concept, the quadrangular cartilage remains preserved in the swinging door technique. The cartilage might be further used in the future for grafting in the hybrid structural/preservation technique if needed, ultimately saving rib cartilage and/or conchal cartilage. Finally, surgery time is reduced, and patient's morbidity remains minimal.

Level Of Evidence Iii: 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 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).