Impact of osteotomies and structural grafts in the management of severe twisted or deviated nasal deformity: a critical analysis of 179 patients with open rhinoplasty.

The aim of this study was to analyze the long term impact of different surgical techniques especially osteotomies and structural grafts especially spreader grafts in terms of functional and aesthetic outcomes in cases of severely deviated nose deformities using open structure rhinoplasty. Retrospective chart reviews of two hundred consecutive patients who underwent corrective rhinoplasty during the period between January 2009 and December 2010 for deviated nasal deformity were performed. Those cases which were done with closed approach (21) were excluded from the study. Analysis included 179 patients, with 136 males and 43 females, and 79.9% had history of trauma pre-operatively. Follow-up period was 6-24months out of which 88.4% were satisfied with the surgery results functionally and aesthetically. There was a statistical significant correlation between omitting osteotomy or using unilateral osteotomy and risk of recurrence or remnant deformity (p value 0.006). Similarly there was also a statistically significant relation between recurrence and placement of unilateral or bilateral spreader graft (p value 0.47). Our results of open approach are considered excellent. There is a significant relation between use of procedures like selection of osteotomies and non-use of spreader graft and the possibility of recurrence. Open structure approach provides improved functional and aesthetic results.