Crooked nose is manifested by nasal deviation with or without septal deviation, while the majority of nasal cartilage cone deviation is accompanied by septal deviation, and the bone and cartilage of nasal septum of such patients deviate from the midline or form restricted protrusions such as crests and spines, and produce corresponding clinical symptoms. The incidence of nasal septal deviation varies greatly due to the lack of strict and uniform quantitative standards, ranging from 12.7% to 81.2% according to domestic and foreign literature, while surgical treatment methods generally include external and internal nasal approach correction (including nasal endoscopy-assisted correction). Reviewing the literature in recent years, we found that endoscopic correction of nasal septal deviation has fully exploited the advantages of minimally invasive surgery, but there seems to be a tendency to completely override other procedures. A retrospective analysis of 58 patients with “nasal septal deviation with nasal cartilage cone deviation” treated in our department in the past 5 years illustrates the rationale and indications for the external nasal approach.