Frequency and Characteristics of Facial Asymmetry in Patients With Deviated Noses

Abstract

Importance

Facial asymmetry is frequently detected in patients who are seeking rhinoplasty for a deviated nose, and its presence often leads to failure to create a straight-looking nose.

Objective

To analyze the frequency and characteristics of facial asymmetry in patients with a deviated nose and to identify representative parameters to describe types and severity of facial asymmetry.

Design, Setting, and Participants

Retrospective review of at a tertiary referral center of preoperative photographs of 152 patients who underwent rhinoplasty for a deviated nose between January 2008 and December 2012. The incidence of facial asymmetry in these patients was compared with the incidence in 60 control patients undergoing septoplasty without external nose deviation.

Interventions

Using frontal photographs, the presence of facial asymmetry and the types of deviated nose were noted and measured by 2 observers.

Main Outcomes and Measures

Facial asymmetry was categorized into 4 types depending on which subunit of the face was affected, and deviated nose shapes were classified into 5 types. Anthropometric measurements were also performed.

Results

Facial asymmetry was more common in patients with a deviated nose (84 of 152 [55%]) than in controls (19 of 60 [32%]) (P = .04). Mixed-type facial asymmetry was the most common type in the patient group. Among the anthropometric measurement parameters, the distance between the midpoint of the interpupil line to the most prominent malar point, lateral canthal angle, lateral alar angle, lip margin angle, and tilted chin angle were significantly different between the patient group and the control group (P < .05 for all comparisons). There was no difference in the incidence of asymmetry with respect to deviation type.

Conclusions and Relevance

Facial asymmetry was more common in patients with a deviated nose than in control patients, and mixed-type facial asymmetry was the asymmetry most often associated with deviated nose. This study suggests that deviated nose may be a developmental defect caused by a discrepancy in the growth of facial bony skeleton between the 2 sides of the face. The objective anthropometric measurements developed in this study could be useful for making appropriate preoperative facial assessments.

Level of Evidence

NA.