Comparative study between different types of intermediate osteotomies in twisted nose deformity management: a randomized controlled trial

The nasal dorsum plays an important role in defining the facial harmony. Osteotomy techniques in rhinoplasty surgery are challenging, as in many cases they require visionless tissue manipulation to achieve an aesthetic facial symmetry. This research elucidates the aesthetic outcome of the different types of intermediate osteotomies for correction of twisted nose deformity. This study was randomized controlled trial on 20 selected patients, divided randomly into 2 groups: group A included 10 patients who underwent routine vertical intermediate nasal osteotomies, while group B involved 10 patients subjected to transverse intermediate nasal osteotomies. Patients were assessed aesthetically both by the surgeon and a layperson based on pre and postoperative VAS scale and frontal view photography. Comparing pre and postoperative VAS showed statistically significant improvement with median score improvement from 8 pre to 1–2 post which is 80% improvement with P value of 0.004 for surgeon and 0.004 for layperson. Comparing the postoperative VAS for both groups showed statistically insignificant difference with P value of 0.106 for surgeon and 0.218 for lay person. Twisted nose deformity is one of the challenging cases in rhinoplasty. Both types of intermediate osteotomies have shown significant improvement in postoperative dorsal aesthetic view. There was no statistically significant difference between either group; yet, more improvement was noted in the transverse type.