Sequential Assessment of External Nasal Deviation Angle Changes in Patients With a Deviated Nose Who Underwent Bilateral Osteotomy

Objective: A deviated nose is traditionally classified as bony, cartilaginous, or combined deviation. Osteotomy is commonly used to correct bony deviation, and accurate surgical techniques and postoperative patient management are important for favorable outcomes. The authors investigated the change in the external nasal deviation angle over time using sequential clinical photographs to identify the optimal postoperative follow-up duration. Methods: Medical records and sequential standardized clinical photographs of 22 patients who underwent bilateral medial and lateral osteotomies without dorsal augmentation from January 1, 2014 to May 31, 2021, were retrospectively reviewed. Clinical photographs were classified into 4 periods: "a" preoperative, "b" postoperative day (POD) <= 3 weeks, "c" POD <= 9 weeks, and "d" POD >9 weeks. The angle of deviation (AoD) was measured in both frontal and chin-on-chest views for each period. Differences in AoD between temporally adjacent periods were analyzed. Results: Nineteen men and 3 women (mean age: 28.8 y) were included. Thirteen patients showed rightward deviation, whereas 9 showed leftward deviation. Eleven patients underwent surgery through an endonasal approach, whereas the other 11 underwent surgery through an external approach. In the frontal view, AoD differences (mean +/- SD) between periods "a" and "b," "b" and "c," and "c" and "d" were 5.79 +/- 3.36 degrees (P < 0.001), 1.44 +/- 1.14 degrees (P < 0.001), and 1.07 +/- 1.24 degrees (P < 0.05), respectively. In the chin-on-chest view, the values were 5.17 +/- 2.69 degrees (P < 0.001), 2.06 +/- 2.63 degrees (P < 0.001), and 1.46 +/- 1.31 degrees (P < 0.001), respectively. No statistically significant difference in AoD differences was observed between the two approaches. Conclusions: Angle of deviation can change even 9 weeks after bilateral osteotomy. Thus, long-term follow-up using sequential clinical photographs is mandatory. If needed, close follow-up with early postoperative interventions may be required. The chin-on-chest view showed better sensitivity for assessing AoD than the frontal view.