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Clinical Challenge
July 6, 2017

The Twisted Nose

Author Affiliations
  • 1Department of Facial Plastic and Reconstructive Surgery, University of Virginia, Charlottesville
JAMA Facial Plast Surg. Published online July 6, 2017. doi:10.1001/jamafacial.2017.0696

A 20-year-old man presented with functional nasal obstruction following facial trauma resulting in fractured nasal bones 5 years prior. He had undergone a closed nasal fracture reduction but experienced persisting obstructive symptoms. He also expressed dissatisfaction with the appearance of his nose. He was otherwise medically well, with mild seasonal allergies (Figure 1). On examination, he was a healthy-appearing man, with clinically significant nasal bone and septal deviation to the right. On palpation, there was a prominent healed fracture line through the left nasal bone, and a narrow middle vault. Anterior rhinoscopy revealed the caudal septum within the right nasal vestibule, with the posterior and dorsal aspect of the septum deviated to the left. The nasal tip was asymmetric with pronounced supratip concavity on the left. There was no evidence of nasal valve collapse.

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