Can My Nasal Deformities After My Jaw Surgery Be Improved By A Rhinoplasty?
Q: Dr. Eppley, I had orthognathic surgery over a year ago where my upper jaw was shortened and my lower jaw was brought forward. Ever since my septum has somehow shifted off to the left side and my nose is slanted that way as well. The left nostril sags down and looks wider as well. The right side looks more normal. What can be done know to correct these nasal problems? I am certain they are the result of my jaw surgery since my nose didn’t look like this before my jaw surgery.
A: Septal and nasal deformities as a result of a LeFort (maxillary) osteotomy are not rare. A LeFort I osteotomy has three potential adverse effects on the nose if certain steps are not taken during the surgery to avoid them. The septum may become deviated afterwards as the floor of the nose is part of the upper jaw. When the maxilla is impacted (shortened, moved upward), the septum must be similarly shortened. If not, the impacting upper jaw will cause it to be bent or deviated as it impinges on it. The nostrils can become wider afterwards as the paranasal muscles are disinserted with the incision under the upper lip. If these muscles are not brought back together at the time of the intraoral mucosal closure with a V-Y advancement, then the sides of the nostrils will flare outwards. Lastly, the tip of the nose can change due to the altered position or shape of the anterior nasal spine on which the caudal end of the septum and columella resides. It appears that you now have some degree of all three of these nasal problems. All of these deformities can be corrected during a secondary septorhinoplasty procedure.
Dr. Barry Eppley