Mobile Bony Cap (Meysem Yorgun Technique): An Innovative Technique in Preservation Rhinoplasty for Crooked Nose Deformity

Overview

A crooked nose is a deviation of the nasal pyramid off the vertical axis, and it remains difficult to correct. The authors describe a closed approach let-down procedure in which the middle vault is preserved and the bony cap, the piece of bone at the top of the bridge, is freed and kept rather than removed. Freeing it releases tension on the dorsal septum and lets it cover small residual asymmetries.

Sections of note

• Design: case series of 25 patients with I-shaped or C-shaped crooked nose deformities, closed approach let-down.
• Technique: the middle vault is preserved, the bony cap is mobilized and kept, and the lateral nasal bones are equalized using either a piezo device or classical osteotomes.
• Stated mechanism: mobilizing the bony cap releases tension on the dorsal septum, and the cap hides slight asymmetries beneath it.
• Result: postoperative angles for both types were closer to the ideal angle, and the difference was statistically significant. No angle values or p values are given in the abstract.
• All patients were reported satisfied with aesthetic and functional results, with no scoring tool named.
• The authors state the method addresses asymmetry at both the lower maxillary nasal junction and the K-point.

What it means for a patient

• The technique aims to straighten a leaning nose without removing the bridge surface or making an external incision.
• Keeping a mobile bony cap gives the surgeon a movable cover that can mask small residual irregularities.
• Limits: 25 patients, single group, no comparison technique, no stated follow up, no numerical results, and satisfaction reported without a validated questionnaire.

Why this paper matters

Preservation techniques were designed for straight noses, and their weakness has been asymmetric ones, where keeping the bridge intact limits what can be corrected. Making the bony cap mobile is one attempt to keep preservation while allowing correction. How it compares to conventional osteotomy is unanswered.

Terms

• Crooked nose deformity: deviation of the nasal pyramid off the vertical midline.
• Bony cap: the small bony segment at the top of the nasal bridge, above the cartilage.
• Let-down: removing a wedge of bone from the side walls so the bridge can settle lower.
• Middle vault: the middle third of the nose, formed by the upper lateral cartilages and septum.
• Piezo device: an ultrasonic instrument that cuts bone while sparing soft tissue.