목적: This study investigated the relationship between severity of bony pyramidal deviation and the implementation of osteotomies in rhinoplasty. 방법:Thirty-four patients who underwent rhinoplasty due to deviated nose were divided into two groups: 17 patients with osteotomies and 17 patients without osteotomies. The severity of bony pyramidal deviation was determined from 4 parameters calculated from axial computed tomography (CT) scans and standard frontal facial photograph with simple linear and angular measurements. Each parameter was evaluated in regard to actual implementation of osteotomies during the surgery. 결과:CT projected length, CT projected angle and photo deviated angle were significantly different between the two groups. Among those variables, projected length difference of bilateral bony pyramid was the most reliable factor in predicting whether osteotomies are needed or not. The cut-off value satisfying reasonable sensitivity and specificity was 1.59mm. There was no statistically significant difference between the two groups in surgical outcomes including postoperative angle of bony pyramidal deviation. 결론:Osteotomies are presumed to be necessary when the projected length difference of bony pyramid measured from axial CT scans is 1.59 mm or more.