The nose is by far the most important aesthetic complex of the face, N
either appearance nor function is expendable, and both should be consi
dered together when nasal surgery is planned. Surgical correction of t
he deviated nose associated with a twisted and severely deviated septu
m is therefore a very difficult surgical challenge, The dilemma of the
surgeon is to fashion a stable and aesthetically pleasing nose togeth
er with restoration af the airway on both sides.Development of mucoper
ichondrial and mucoperiosteal flaps bilaterally, total removal of the
deviated septum, straightening it outside, followed by replacement as
a free graft constitute an option in treatment of tile severely deviat
ed nose. Although King and Ashley(1) described the total removal of th
e deviated septum in a single piece to correct such severe nasal devia
tions for the first time, the principles and indications of this techn
ique were established and published in detail by Rees.(2) Positioning
and stabilization of tile septal cartilage in this technique may prove
insufficient in the majority of such septorhinoplasty patients, in wh
om both nasal hones are also immobilized, Fear of collapse of the nasa
l dorsum, which is likely to occur, after 1 replacement of septal cart
ilage as a free transplant has led me to develop the technique present
ed here: the external cantilever sling.