Evaluation of nasal axis deviation correction using the sliding spreader flap technique in primary rhinoplasty of the crooked nose

Correction of the crooked nose remains challenging because deformity may involve the nasal septum, middle vault, and upper lateral cartilages. The Sliding Spreader Flap (SSF) technique is an alternative approach for midvault reconstruction, but data on changes in nasal axis deviation following its use remain limited. This study aimed to quantify changes in nasal axis deviation after primary rhinoplasty using the SSF technique using angular photographic analysis. This prospective case series included 32 female patients with crooked nose deformity who underwent open rhinoplasty using the SSF technique between April 2022 and April 2024 at Firoozgar Hospital, Iran University of Medical Sciences. Patients were followed for 12 months. Nasal axis deviation was measured on frontal photographs using ImageMeter software. The primary outcome was change in nasal axis deviation angle from baseline to 12 months postoperatively; a decrease toward 0° indicated improvement toward the facial midline. Functional outcomes were assessed using the NOSE questionnaire. Mean age was 30.7 ± 5.7 years. Mean nasal axis deviation decreased from 8.5 ± 2.4° preoperatively to 1.7 ± 1.1° at 12 months (correction, 6.7 ± 1.9°; P < 0.001), corresponding to a mean correction rate of 79.8 ± 9.5%. Fifteen patients (46.9%) remained deviated in the same direction, whereas 17 (53.1%) crossed the 0° midline and were classified as directional overcorrection. Correction rates were similar between groups (79.8 ± 8.4% vs. 79.7 ± 10.6%, P > 0.05). The mean NOSE score decreased from 62.4 ± 14.1 to 55.6 ± 15.0, but this change was not statistically significant ( P = 0.08). Primary rhinoplasty using the SSF technique was associated with substantial reduction in nasal axis deviation at 12 months in this cohort. However, the case-series design does not establish the contribution or superiority of SSF, and no significant improvement in NOSE scores was demonstrated. Larger comparative studies with repeated measurements and three-dimensional assessment are warranted.