ABSTRACT
Management of the twisted nose can be a challenging endeavor for experienced rhinoplasty surgeons. To be effective, the surgeon must first understand the etiology of the deformity, which varies from patient to patient. Once established, treatment of the external nasal deviation can be better guided to achieve the desired result. External nasal deviations arise from two broad categories: traumatic and developmental.(1) Traumatic deformity is quite common as the position of the nose off of the facial plane makes it susceptible to injury. Adult injuries tend to involve the upper half of the nose while pediatric injuries result in displacement of the lower half. Since facial asymmetry is prevalent in more than 90% of the population, it must be identified and discussed before undertaking repair.(Figure 16.1) These types of asymmetry may be inherited or due to abnormal growth patterns in the midface after childhood injury.
