One-Unit Osteotomy to Correct Deviated Bony Dorsum

Objectives. A crooked nose is frequently caused by nasal bony vault deviation, and proper management of the bony vault is an integral part of rhinoplasty. Conventional osteotomy to correct a deviated nose favors simultaneous medial and lateral osteotomies, which allows the free independent movement of each nasal bone. However, patient satisfaction with deviated nose surgery is sometimes low. In the present study, we introduce a one-unit osteotomy procedure that combines bilateral and root osteotomies with unilateral triangular bony wedge resection to allow symmetry of both nasal bones. Methods. Twenty consecutive patients who presented with bony vault deviation and underwent one-unit osteotomy were enrolled in this retrospective single-center study. The Nasal Obstruction Symptom Evaluation (NOSE) questionnaire was used to evaluate each patient's functional outcome. The angle of bony vault deviation before and after one-unit osteotomy was measured using a protractor and compared with the results of 14 patients who had undergone conventional osteotomy. The improvement in dorsal deviation was evaluated using facial photography preoperatively and 3 months postoperatively. Results. NOSE values improved from 8.4 +/- 6.4 to 4.1 +/- 4.2 (P= 0.021). The angle of bony vault deviation improved from 6.9 degrees +/- 2.2 degrees to 2.1 degrees +/- 1.2 degrees (P<0.001) in one-unit osteotomy and from 7.3 degrees +/- 4.0 degrees to 2.7 degrees +/- 1.2 degrees (P= 0.001) in conventional osteotomy. The preoperative deviation angle improved by 70.3% in one-unit osteotomy compared with 56.6% in conventional osteotomy, which was a significant difference (P= 0.033). The mean grade of the postoperative esthetic outcomes for the remaining deviation was 1.6 +/- 0.5, which was similar to that in the conventional osteotomy group. Conclusion. One-unit osteotomy is a relatively simple procedure that balances the width of both lateral walls by removing excessive bony fragments from the wider bony wall and providing better structural integrity. This technique improves functional outcomes and has equivalent esthetic results to those of the traditional procedure.