LAUSR

Facial asymmetry is very common in the normal population. This asymmetry, which most likely is controlled genetically, has a substantial effect on the total facial skeleton. The nasal skeleton usually deviates toward the shorter, less developed side of the face. This asymmetric facial growth affects all the nasal structures including the nasal bone, septum, and upper and lower lateral cartilages [1]. During last decades, there was described a wide range of surgical techniques to straighten the nose and maximize nasal function. To treat the bony pyramid of the nose, medial, transverse, lateral, intermediate, asymmetric and multiple osteotomies were used to allow total movement of the bony walls [2]. But despite this, management of the osseocartilaginous vault continues to present challenges for rhinoplasty surgeons, especially regarding the inherent asymmetry of the bony vault and the need for a highly individualized approach for each case [3]. The author in this paper described his algorithm, based on 4 developmentally related parameters, which he used for choosing the position and number of lateral osteotomies in cases of slightly deviated bony pyramids [4]. Among these parameters are: septal position in nasal floor, external alar length, lateral pyramidal length and frontal pyramidal deviation’s starting side. Analysis of those parameters was helping to more accurately understand which side of the bony pyramid was longer, and during the operation, either high lateral or double lateral osteotomy was performed on the longer side. On the bony pyramid’s shorter side, the lateral osteotomy was performed in the nasofacial groove. At the same time, a high lateral osteotomy was performed on the longer side at a level equal to the distance from the midline of the nose to the nasofacial groove on the short side. If the distance from this level to the nasofacial groove was greater than 1 mm, a double lateral osteotomy was performed by making another osteotomy on the level of nasofacial groove. From my point of view, the algorithm and technique for correcting a slight deviation of the bony pyramid, which was presented by the author, look like a useful addition to the already existing methods for analyzing crooked noses and techniques for their correction. Thus, the described algorithm for determining the longer side on the bony pyramid implies not only the analysis of the bony pyramid itself, but also the septum, and the position of the alar cartilages, which again confirms the importance of 3-dimensional (3D) analysis in planning the treatment of even a slight deviation of the nasal dorsum, where every detail can have an impact on the future result. Also, the author points out to the importance of performing asymmetric lateral osteotomies for the treatment of asymmetric nasal bones, which is an integral component in modern surgery of crooked noses. Thus, this study looks very interesting; well-presented results demonstrate good improvement. There are, however, some issues that should be considered: & Vitaly Zholtikov [email protected]