Multifactorial Subgroup Analysis of Surgical Strategy Selection for Different Types of Deviated Nose: A Comparative Study Based on Subjective and Objective Outcomes.

Abstract

Nasal deviation adversely impacts both airway function and facial aesthetics. The optimal surgical approach remains debated, particularly regarding how structural complexity modifies postoperative outcomes. The aims of the study were to evaluate the interaction between nasal deviation type and surgical method on functional and aesthetic results and to propose a structure-guided algorithm for surgical selection. We retrospectively analyzed 78 patients who underwent surgical correction of nasal deviation. Deformities were classified as Type I (linear), Type C (curved), or Type S (twisted) based on clinical examination and CT findings. Surgical techniques included septoplasty, rhinoplasty, septorhinoplasty, and comprehensive functional procedures. Outcomes were assessed using NOSE and ROE scores, CT-derived anatomical parameters, and complication rates. Generalized linear models were applied to examine the effects of deviation type, surgical method, and their interaction on postoperative improvements. Both deviation type and surgical method were significant predictors of NOSE and ROE improvement (P < 0.05). Generalized linear model analysis confirmed a significant interaction between deviation type and surgical method (P = 0.016 for NOSE; P = 0.049 for ROE). Complex deviations (Type C and Type S) achieved the greatest functional and aesthetic benefit from septorhinoplasty or comprehensive surgery. Mild, self-limited aesthetic complications occurred in 13.5% of cases, with no persistent functional impairments. Structural complexity significantly affects surgical outcomes in deviated nose correction. Matching surgical strategy to deviation type-especially employing combined or advanced techniques for complex deformities-optimizes both functional and aesthetic improvements. These findings support a structure-strategy matching model for individualized surgical planning in nasal deformity management.