Armando Boccieri - Gobba Nasale
SADDLE NOSE
SADDLE NOSE

Saddle nose is characterized by shortness of the nasal dorsum, which is clearly evident in profile and due to various deficiencies of the osseous and/or cartilaginous structure.

The condition can have congenital causes such as syphilis or intrauterine trauma, but is more often the result of trauma, the use of cocaine, and previous septorhinoplasty. The latter iatrogenic cause, due to the removal of an excessive portion of the nasal dorsum in order to eliminate a hump during rhinoplasty, is the most frequent.

While its correction involves the insertion of a graft, this procedure must be part of an overall plan of anatomical reconstruction for all the deficient structures. If we are to obtain a excellent results in secondary rhinoplasty, it is in fact often necessary also to reconstruct other structures mutilated or weakened during the previous operation, such as the cartilages of the nasal tip, wings or septum. The grafts used for this purpose can be of cartilage harvested in order of preference from the nasal septum, the auricular concha and the rib. The choice depends on the amount of cartilage required for reconstruction and the availability of material in the different areas.

 

 
A SAD EXPRESSION CAUSED BY SADDLE NOSE

This patient underwent rhinoplasty to remove a hump some years earlier and now complained of a sunken nasal dorsum and impaired respiration.

Preoperative analysis revealed iatrogenic saddle nose with drooping of the nasal tip and columella. Rhinoscopy also revealed perforation of the nasal septum.

Secondary rhinoplasty was executed by means of grafts of cartilage taken from both the auricular conchae in order to reconstruct the nasal dorsum and strengthen the columella with a strut. The nasal tip was also reshaped and rotated upwards. The perforation of the nasal septum was repaired with strips of the local mucosa. The postoperative photographs show a marked change for the better in the sad expression present before the operation, which is typical of patients suffering from saddle nose.

 
A “SURGICAL” NOSE

This patient came to me after two previous rhinoplasties with a marked saddle nose, asymmetry of the nasal tip and irritating respiratory problems. She was very dissatisfied with what she described as her excessively short “surgical” nose and bewildered the fact that another surgeon consulted before me had suggested a corrective operation with the further removal of nasal structures!

Preoperative analysis revealed the results of particularly aggressive prior operations. The patient presented depression of the nasal dorsum, a short nose, an asymmetric nasal tip with pinching of the nasal wings, and absence of the cartilaginous nasal septum. Revision rhinoplasty with open access was carried out with grafts from both the auricular conchae in order to correct the saddle nose and reconstruct the nasal septum and the cartilages of the tip. Further alar batten grafts of auricular cartilage were used to correct the pinching of the nasal wings. The results proved stable three years after the operation.

I published the case described here in 2006 in the article ‘A Difficult Revision Case: Two Previous Septo-Rhinoplasties,’ Facial Plastic Surgery Clinics of North America, November 2006, 14(4), pp. 407–09.

 

 
CORRECTION OF SADDLE NOSE WITH RIB GRAFT

This young patient came to me with a serious case of saddle nose caused by major trauma to the nasal pyramid in early childhood and severely impaired respiration. His state of mind was understandably characterized by great anxiety about the present situation and apprehension as to the results of the operation.

Clinical analysis of the patient revealed extreme deficiency of all the osseous and cartilaginous nasal structures, which failed to grow normally due to the childhood trauma. Given the need for a large amount of cartilaginous material for reconstruction, the deformity was corrected by means of rib grafts on the nasal dorsum and columella.

 
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