Surgical Technique
After preparing the surgical field, patients were covered with sterile surgical cloths. After local anesthetic administration, the closed approach let-down technique is preferred. Infracartilaginous and marginal incisions were applied. Supraperichondrial and subperiosteal dissection was performed carefully. Wide subperiosteal dissection is essential for better visualization and control of lateral osteotomies and ostectomies. First, the lateral nasal walls were measured and recorded. Planned lateral nasal walls were calculated according to the hump and equalized on both sides. First, osteotomies were localized 2-3 mm below the bony cap and with an average of 8 to 10 mm in size, and their connection with the upper lateral cartilages was preserved on both sides. Mobilization of the bony cap allows the cartilage to move freely, and this maneuver helps the correction of the middle third deviation. Subsequently, we left 15 to 18 mm of lateral nasal bone on both sides with an equal size and shape just below the mobile bony cap and took the excessive bones between the lateral osteotomy lines and maxillary bone to prevent step deformities and the recurrence of deviations. Bony pyramid deviation is corrected with this asymmetric reduction of the bone on both sides. The important point is that the residual lateral nasal bone sizes left in the patient should be equal for symmetry. Lower strip resection of the septum and a lower strip cut in the perpendicular plate of the ethmoid bone were performed, and the let-down procedure was completed. In our technique, to correct the 3-dimensional asymmetry in the lateral nasal bones, the dimensions of the lateral nasal bones are measured and equalized. The bony cap is mobilized and preserved to hide the slight asymmetries below and release the tension on the dorsal septum. A schematic diagram of the surgery is provided in Figure 1.
The SPSS statistical package (version 15.0; Chicago, IL) was used for all data analyses. Preoperative and postoperative angles were compared by a dependent t test for both I- and C-type deformities separately, and a statistically significant p value was accepted as <0.05.