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Saddle Nose Deformity
A saddle nose deformity derives its name from the appearance of the nose on lateral view as the dorsal curve resembles the depression in a horse's saddle. The gross deficiency that exists in the dorsum of the nose, no matter the etiology, creates an obvious and progressive scooped-out deformity. When viewed frontally, an illusory excessive width exists across the bridge. The first paper written on the treatment of saddle nose deformity was John Orlando Roe's original article in 1887, “The deformity termed ‘Pug-Nose’ and its correction by a simple operation.” The first attempt at correction of saddle nose deformity occurred when Robert F. Weir implanted the breastbone of a duck into the shrunken nose of a syphilitic patient in 1892. In 1896, Israel was the first to use a human bone graft to the nose. Many authors have published articles detailing the etiology, classification, and treatment of this deformity. Most recently, Daniel and Brenner published a classification of saddle nose deformity with a focus on septal saddling. In this article, the authors describe their approach to the treatment of these deformities as they address each component separately.
Definition
The term “saddle nose deformity” is a pathologic entity resulting from loss of dorsal height, caused by a substantial decrease in the cartilaginous vault and/or bony vault. It may include any of a variety of features: (1) middle vault and dorsal depression, (2) loss of tip support and definition, (3) columellar retrusion, (4) shortened vertical length, (4) tip overrotation, and (5) retrusion of the nasal spine and caudal septum. Regardless of the etiology, the central underlying defect is lost integrity of the bony and cartilaginous dorsum resulting in a short nose with compromised support.
Saddle nose deformity can occur following a variety of nasal pathologic conditions. The majority of saddle nose deformities are acquired (secondary to trauma, septal hematoma, septorhinoplasty to correct traumatic injuries, cocaine abuse, infection, and cosmetic septorhinoplasty), but congenital causes do exist (i.e., Binder syndrome). Although it is difficult to assess the true prevalence of nasal saddling in any given population, certain groups of patients seem to be particularly prone. Facial trauma victims, cocaine abusers, and patients who have undergone previous septorhinoplasty, particularly following traumatic injury, seem to be at highest risk.
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