Objective This article describes a simplified endonasal approach compared with traditional techniques for the correction of crooked noses by using endoscopic tension-relaxing septoplasty in the absence of nasal splints, with attempts to improve both the aesthetic appearance and functionality. Study Design A retrospective study was conducted at our institution with all 26 patients who underwent tension-relaxing rhinoseptoplasty by endoscope between November 2008 and January 2013. Methods Patients who were concerned about their aesthetic appearance and nasal obstruction were subjected to anterior rhinoscopy, endoscopic examination of the nasal cavity, and computed tomography for the evaluation of correlations among deformity of the nasal structures and nasal airway. The tension-relaxing method was used in the endoscopic rhinoseptoplasty by an endonasal approach. We introduced this technique in the surgery for patients with a C- or an I-shaped crooked nose. Subjective (visual analog scale) and objective (quantitative electronic meter measurement) assessments were used to evaluate aesthetic appearance. Validated Nasal Obstruction Symptom Evaluation scale and active anterior rhinomanometry were used to assess nasal obstruction. Results All the patients indicated cosmetic satisfaction and reduced nasal obstruction. In cases with I-shaped and C-shaped crooked nose deformities, pre-and postoperative angle values (mean ± standard deviation) were 13.35 ± 3.36° versus 1.85 ± 1.66° (n = 15) and 153.69 ± 6.48° versus 176.64 ± 2.32° (n = 11), respectively. Postoperative correction rates were statistically significant (p < 0.001) in both groups. Results from active anterior rhinomanometry indicated significant improvement in objective nasal obstruction from a mean baseline value of 0.56 ± 0.07 Pa/cm3/s (range, 0.43- 0.69 Pa/cm3/s), to a 12-month value of 0.26 ± 0.02 Pa/cm3/s (range, 0.23-0.29 Pa/cm3/s) (p < 0.001). The mean rhinoseptoplasty duration time was 19.00 ± 3.53 minutes. The nose deformities were significantly improved, with no recurrences of septal deviation or crooked nose, nor complications of septal perforation and nasal infection 12 months after the operation. Conclusion This simple technique is feasible and minimally invasive, and may be particularly beneficial to patients with a deviated septum who seek to improve both their aesthetic appearance and nasal functionality. However, this method is not appropriate for those with a crooked nose caused by nasal bone deformity, lateral cartilages, and severe septal deformity.
