Introduction:
The deviated nose represents a complex cosmetic and functional problem. To correct the crooked nose, the most performed operation is septorhinoplasty, by a plastic surgeon or otorhinolaryngologist(ENT) to manage the deformed structure. The aim of the study is to investigate the effect of a combined operation by the plastic surgeon and ENT, compared with performing an operation by a plastic surgeon alone on the functional and aesthetic results.

Methods
From January 2017 to January 2022, 99 patients with deviated noses were treated in our institution, 60 patients received combined operations and 39 patients received an operation by a plastic surgeon alone. In the combined operation group, ENT performed endonasal septoplasty and turbinoplasty, and the plastic surgeon performed open rhinoplasty, osteotomies, caudal septal deviation correction, camouflague procedure, aesthetic enhancement, and dorsal augmentation if needed. At the end of the surgery, the ENT checked the airway and applied nasal tamponade. The follow-up period was at least 6 months. Treatment outcomes were evaluated subjectively by questionnaire due to the objective outcome was hard to evaluate during the COVID-19 period.

Result
79 patients answered the RHINO questionnaire, where 33 patients received an operation by the plastic surgeon and 46 patients received combined operation. All cases showed improved scores on RHINO questionnaire after the operation and significant improvement was noted in combine group. (p=0.020). In addition, in the combine operation group, a more significant improvement in airway function was noted. The operation time had relatively long at the early stage of the study but decrease, eventually.
Conclusion
Combine surgery by the plastic surgeon and ENT could effectively treat the crooked nose, especially in functional outcomes.

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