Multifactorial Subgroup Analysis of Surgical Strategy Selection for Different Types of Deviated Nose

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BACKGROUND: Nasal deviation adversely impacts both airway function and facial aesthetics. The optimal surgical approach remains debated, particularly regarding how structural complexity modifies postoperative outcomes. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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