The 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 affected 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
A few years earlire, this patient underwent rhinoplasty to remove a hump and the outcome brought to a sunken nasal dorsum and impaired respiration.

Preoperative analysis revealed a iatrogenic saddle nose with a drooping 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 significant change for the better about the sad expression prior to 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 was bewildered at the fact that another surgeon that was consulted before me had suggested a corrective operation with a 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 taken 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.

Patient Testimonial

“I am here to witness my personal experience. About 13 years ago I decided to underwent nasal surgery for a cosmetic problem, and as inexperienced as I was I went to a doctor that was recommended by a friend. After the first surgery, I began right away to have respiratory and aesthetic problems: my nose was completely "collapsed". In the throes of a constant desperation, I contacted again the doctor who operated on me and after a few months I underwent a new surgery that permanently worsened the situation, already compromised. The negative outcome of the operation brought about in me years of isolation and loss of self-esteem.

In order to resolve the problem in a definitive way, the negativity that characterized me, both physically and psychologically, I performed much research on specialized professionals in the field of rhinoplasty reconstruction. After numerous attempts and advice, I contacted Prof. Boccieri that immediately struck me for its professionalism and sensitivity. By virtue of this, I decided to trust his competence and after six hours of surgery and subsequent monitoring visits he made me regain my natural appearance and consequently self-esteem.

I will remain forever grateful to him! In fact, apart from the great professional competence, he has always shown me great sensitivity and psychological closeness, sending me the confidence that gave me the strength to face further surgery succeeded to perfection.

M. F.

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.