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Saddle nose deformity refers to a collapsed nasal bridge, or loss of nasal height. The “saddle” in the name of this condition is used to describe the appearance of a sagging middle portion (also known as the mid vault region) of the nose.
Figure-1: Before and after photos of a Saddle Nose Deformity. The patient sustained trauma to the nasal bridge that caused a fracture of his septum. In the before photo, please note the part of the bridge which has collapsed above the tip of the nose. This is caused by collapse of the nasal septum, a key structural component of the nose.
There are many things that can cause loss of nasal height. The nasal septum is key to the structural integrity of the nose. It is essentially the central pillar of the nose, providing a majority of its structural stability. Any condition that compromises the nasal septum can lead to a collapse of the nose. Regardless of the cause, the end result will often be the nose taking on a sunken appearance.
Prior Surgery. Prior septoplasty or septorhinoplasty surgery may lead to a saddling of the nose. If an aggressive septoplasty is performed which removes the majority of the septum, this can lead to weakening, and even collapse, of the nose over time. Additionally, any septoplasty procedures performed in patients that are too young can result in a saddling of the nose later on as individuals grow.
Trauma. Trauma is the number one cause of nasal saddling. Any trauma to the nose can lead to saddling or sagging of the nose. If the septum is fractured during trauma, it becomes weakened, resulting in loss of nasal height.
Septal Hematoma and Septal Abscess. Collection of blood or pus in the septum – either from trauma, surgery, or manipulation of the septum – may compromise blood flow to the septum, causing nasal saddling.
Autoimmune and Vascular Disorders. Autoimmune and vascular disorders may lead to vasculitis (or inflammation of blood vessels) in the septum. This inflammation leads to decreased blood flow to the septum, which can result in tissue necrosis and loss. Disease progression leads to weakening of the septum and loss of nasal height. Example disorders include Wegener’s Granulomatosis and Relapsing Polychondritis.
Cocaine Use. Chronic or long-standing cocaine use will also decrease blood flow to the nasal septum, causing tissue necrosis and loss. This ultimately leads to shrinking of the nasal septum and loss of nasal height.
Infections. Chronic infections such as syphilis may also compromise blood flow to the nose and septum, leading to nasal saddling.
The number one symptom is an external deformity of the nose with a characteristic sunken appearance. However, because of where the deformity is located and the likelihood that it was contributed to by poor healing, you may also experience difficulty breathing through one or both of your nostrils. Additional symptoms may include nasal septal perforation, chronic crusting, nose bleeds, and nasal discomfort.
Surgery is usually the preferred method of correcting a saddle nose deformity through an open rhinoplasty approach. If the issue is caused by an overly aggressive previous rhinoplasty or septoplasty, then secondary rhinoplasty surgery may be necessary. Often, grafting material such as rib grafts may need to be used in order to correct the deformity.
Yes. Dr. Mourad is an expert in the surgical repair of saddle nose deformities. He has a high-volume practice who specializes in rhinoplasty surgery to correct saddle nose as well as other complex deformities of the nose. He is a double board certified facial plastic surgeon with expertise in revision rhinoplasty surgery. Below are example photographs of patients that have undergone corrective surgery of saddle nose deformities.
Figure-2: Before and after photo of patient with nasal saddling from trauma. Note the restored contour and height of the nasal bridge.
Figure-3: Before and after photo of patient with nasal saddling. The patient had two prior septoplasty surgeries with overly aggressive removal of the septum which resulted in nasal saddling.