Bony/Cartilaginous Mismatch: A radiologic investigation into the etiology of tension nose deformity.

Background: Tension nose deformity is believed to be due to an "oversized" septal quadrangular cartilage. Prior studies have shown that quadrangular cartilage size is relatively consistent in size in populations. We hypothesize that the tension nose deformity is actually due to an external extrusion of a normal sized septal cartilage from an undersized bony septal encasement. Methods: A retrospective case-control study of sagittal CT scans was conducted, measuring the perimeter and surface area of the quadrangular cartilage and bony septal aperture in tension nose cases and controls. Statistical analysis was performed. Results: Of 23 patients enrolled in the study, 12 patients were sorted into the tension nose group, while 11 patients were considered controls. Both groups had similar perimeter and surface area of their quadrangular cartilage, without statistical difference between the two groups. However, the tension nose group had a statistically significant reduction in bony septal aperture perimeter when compared to controls (p