Approach in the treatment of the deviated and hump nose
Vladinir M. Ezrohin
Nina E. Givirovskaya
Veronika A. Pavlovich
Received: 27 March 2010 / Accepted: 16 November 2010 / Published online: 27 January 2011
Abstract Surgical management of the deviated nose still
constitutes a problem for plastic surgeons because of the
possibility of recurrence and the risk of weakening the
supporting structures. The authors present their experience
with correction of deviated and hump nose that takes into
account both aspects of the problem. The technique does
not destroy the osteo-cartilaginous nasal pyramid structure.
The main thing to reduce the recurrence rate of nasal
curvature is nasal pyramid fixation with impression.
Keywords Nasal deviation
Successful correction of the combined nose deformity
remains one of the most difficult management problems
for the plastic surgeon [1, 2].
The goal of the management of severe deformities is to
produce a straight nose that functions properly. Both
cosmetic and functional aspects of the nose must be
addressed. There is a considerable number of ways of
deviated nose correction, but one problem remains high
percent of deformation relapses. According to Murray ,
this is from 30% to 40%, Waldron et al.  from 40% to
42%, and Rohrich and Adams  from 14% to 50%.
Bony deviations can frequently be corrected by
osteotomies or creating controlled fractures in the nasal
bones and shifting them back to the midline. Correction of
the deviated nose carries the risk of weakening the
supporting structures. The problem becomes more difficult
when the deviated nose is combined with a nasal hump
deformity. As to the elimination of a deviated nose in
patients with a hump nose, several authors suggest to lower
the nose bridge height with a removal method and then to
start curvature elimination [1, 2, 5]. However, such a way
of correction results in a high percentage of relapse. The
boney basis of a nose is claimed to lose structural properties
and weaken when the nose curvature is removed with
simultaneous hump reduction. It reduces tissue stability in
the course of healing and scarring.
Our approach to deviated and hump nose repair is
We offer a surgical technique of nasal curvature elimination
with simultaneous reduction of back height without
destruction of its structure.
All the patients have open rhinoplasties under general
anesthesia. Surgical access is obtained using endonasal
rhinoplasty technique with intercartilaginous incision,
which gives access to the cartilaginous and bony dorsum.
Endonasal incision is performed behind the medial wall of
greater alar cartilage to spina nasalis. The incision is
extended to the arch and lateral wall of the greater alar
cartilage. The skin of nasal tip and dorsum is detached.
Correction of the septal deformity is one of the basic
procedures. Repositioning of the bony and the cartilaginous
pyramid is impossible without mobilization and repositioning
of the septum. The septum is approached through a caudal
septal incision. The cartilagenous and bony nasal septum are
V. M. Ezrohin
N. E. Givirovskaya (*)
V. A. Pavlovich
Department of Maxillo-Facial Plastic Surgery,
Moscow Regional Research
Clinical Institute named by M.F. Vladimirskiy,
Eur J Plast Surg (2011) 34:445–448