Management algorithm for orthognathic surgery with and without simultaneously rhinoplasty

Orthognathic surgery is one of the procedures with the greatest impact on facial aesthetic changes. However, its results can be further enhanced when combined with rhinoplasty, highlighting the importance of evaluating and considering the integration of these procedures. To propose a management algorithm for assessing nasal morphology in patients with facial skeletal deformities and to determine possible surgical alternatives. A retrospective study was conducted, evaluating photographic records of patients who underwent combined orthognathic surgery and rhinoplasty, as well as isolated orthognathic surgery, at a private institution (CIMAX, Lechería, Venezuela) between July 2016 and October 2023, with a minimum follow-up of 12 months. A common pattern of nasal characteristics in Class II and Class III patients related to maxillary morphology was identified and established as a nasal deformity associated with skeletal deformity. Conversely, patients presenting nasal characteristics that did not follow the associated pattern were classified as having intrinsic nasal deformities. A classification system comprising seven patient types was developed, based on the relationship between skeletal and nasal deformities and their corresponding management approaches. The proposed classification serves as a practical guide for diagnosis and clinical decision-making in the correction of nasal components in conjunction with orthognathic surgery.