Saddle Nose Deformity
Saddle nose deformity or nasal dorsum collapse is not a common deformity of the nose but is definitely a devastating condition that will require a Rhinoplasty or nose job. The saddle nose deformity is due to the loss of cartilage support in the mid nose and which is associated with loss or weakness of the septum cartilage. This condition results in the deformity and depression of the middle part of the nose. In even more severe circumstances, the nasal dorsum leads to the upward rotation of the nasal tip, by shortening the nose and the nasal obstruction. Therefore a saddle nose deformity may lead to self-consciousness, depression, etc.
What causes saddle nose deformity?
The core cause of a saddle nose deformity is the loss of nasal cartilage support. The cartilages may also include the septum, upper lateral cartilages, and lower lateral cartilages. There are numerous causes that can lead to the cartilage loss.
However, the saddle nose deformity is most commonly classified into three stages according to the severity of the condition-
- Stage 1- This includes minimal depression above the supratip of the nose and due to the loss of septal support which may be associated with minimum columellar retraction of the projection of the nasal tip.
- Stage2- It has a moderate depression of the dorsum which is not more than 5mm. In this stage, the septum support alters the normal anatomical relations of the nasal septum with the surrounding cartilaginous structure. The nasal tip loses the projection and rotates upward.
- Stage3- The third stage of saddle nose runs in the dearth of a major bony and cartilaginous structure support. The nose tip misses, even more, projection and the nostril orientation is also distorted.
Saddle nose deformity from nasal fracture:
Nasal trauma may also give rise to saddle nose deformity if a blood clot forms under the septal skin lining. This condition may disrupt the normal blood supply under the septal skin lining. This results in the disturbance of the normal blood supply of the cartilage which if left untreated can cause the disintegration of the cartilage. If the injured portion of the septum is located in elevation towards the bridge then the skin may appear depressed due to the dearth of support.
Medical problems that may cause saddle nose deformity:
One of the medical issues that may give rise to saddle nose deformity is Wegener’s Granulomatosis which is a systemic disease and may lead to the inflammation of the blood vessels and microabscesses in the upper respiratory tract. This may also lead to the destruction of the cartilage over time.
Also Read: Benefits of Rhinoplasty
Another medical condition Relapsing polychondritis which is a disease that produces the recurrent episodes of autoimmune cartilage inflammation and destruction of the nose, ears, trachea, and joints. Additional causes of saddle nose deformities are syphilis and leprosy.
Surgical treatment procedure:
Depending on the degree of saddle nose, there are various reconstructive options that can be used to treat the condition. The history of nasal reconstruction procedures includes the use of implants and grafts that is extracted from a variety of sources. However, following are the techniques by which a saddle nose can be rectified-
- Autografts- auricular cartilage, rib ad patients finger
- Homograft- Irradiated rib, pooled acellular dermis
- Xenografts- Leather, bovine cartilage
- Precious metals- like gold, silver, titanium
- Synthetic products- silicone, polyamide mesh, etc
Autogenous graft repair:
Autogenous graft repair consists the use of alloplastic implants which is preferred by most of the surgeons since it diminishes the infection rate, extrusion rate, and the biocompatibility concerns. Septal cartilage is thus one of the best choices. However, the secondary sources of autogenous cartilage include the use of auricular and rib cartilage. These cartilages are obtained from the ear and are best suited for the use of the nose. The bone grafts harvested from calvarial, iliac and tibial bone sources may also be utilised. The surgical procedure is carried on through an open rhinoplasty approach.
Open Rhinoplasty usually gives the surgeon a clear access to the cartilage and bone of the nose. The procedure includes making incisions across the columella and the surgeon can easily elevate the skin of the nasal tip of the nose. The cartilage is then shaped very precisely to achieve the desired outcome. The final results are not visible immediately after the surgery due to the presence of some amount of swelling and bruising. The incision mark will be visible even after complete healing. The surgical procedure is performed under general anesthesia. The results may last for longer than ten years depending on the particular approach.
Most of the patients do not encounter any issues after undergoing a saddle nose surgery. However, the potential complications may include:
Infection, allergic reaction to anesthesia, nasal obstruction, visibility of graft, displacement of the cartilage, crooked nose deformity, alar-columellar disproportion, loss of sensation in the nose tip, poly beak deformity, etc.