Nasal Deviation and Facial Asymmetry in Patients Undergoing Rhinoplasty

Overview

Whether a crooked nose comes mainly from injury or from the face growing unevenly has been argued both ways. The authors measured the prevalence of nasal trauma and facial asymmetry in rhinoplasty patients and tested whether the direction of facial asymmetry matches the direction of nasal deviation. Charts and clinical photographs were reviewed for patients operated on by the senior author over 12 months.

Sections of note

• Design: retrospective chart and photograph review, single surgeon, 12 months. 144 patients had rhinoplasty; 68 revision cases were excluded, leaving 76 primary patients.
• Prevalence: 9 percent reported prior trauma, 68 percent had deviated nasal bones, 46 percent deviated tips, 70 percent asymmetric midfaces, 36 percent deviated chins.
• In patients with no trauma history, the nasal bones most often deviated toward the side of midface underdevelopment, 53 percent, p equal to 0.008.
• The nasal tip most often deviated to the side opposite the septal deviation, 59 percent, p equal to 0.001.
• No association was found between nasal bone deviation and chin deviation, or between tip deviation and midface underdevelopment or chin deviation.
• Stated conclusion: nasal deviation is primarily driven by asymmetric facial growth rather than trauma.

What it means for a patient

• Most people with a crooked nose in this series had never broken it. Their faces had grown unevenly.
• The bony nose and the tip deviate for different reasons, so straightening one does not automatically straighten the other.
• If the underlying cause is facial asymmetry, the nose can be centred on the face but the face itself will remain asymmetric.
• Limits: 76 patients, one surgeon, trauma history self reported, and asymmetry assessed from clinical photographs rather than imaging.

Why this paper matters

Whether nasal deviation is a healed injury or a growth pattern changes what a surgeon expects to find and how far correction can go. Documenting that facial asymmetry is far more common than trauma reframes the problem. What proportion of correction is achievable when the underlying face is asymmetric is unanswered.

Terms

• Nasal deviation: a nose whose axis leans off the facial midline.
• Midface hypoplasia: underdevelopment of the middle third of the face on one side.
• Septal deviation: bending of the wall dividing the two sides of the nose.
• Laterality: which side of the body a feature is on.