Saddle nose deformity is a pathological entity resulting from loss of dorsal height, caused by a substantial decrease in the support structures of the nose. This can include either the cartilaginous vault and/or the bony vault.
There are several features that are characteristic of Saddle Nose Deformity:
1) a visible or palpable depression of the nasal bridge (profile)
2) severe loss of tip support (and loss of definition)
3) columella retrusion (nasal base skin between the nostrils)
4) shortened vertical length of the nose
5) overly rotated nasal tip (i.e. pug-nose appearance)
Irrespective of the cause, the central underlying defect is lost integrity of the nasal bones and cartilage along the bridge resulting in a short nose with compromised support.
Saddle nose deformity can occur following a variety of nasal conditions, and needs to be screened for in the Los Angeles rhinoplasty patient. The majority of saddle nose deformities are acquired (i.e. as a result of trauma, untreated septal bleed/hematoma, previous surgery to correct traumatic injuries, cocaine abuse, infection, and cosmetic nasal surgery). 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. The patient shown above required nasal reconstruction with rib grafts, ear cartilage composite grafts, and deep temporal fascia grafts in order to correct her myriad of problems.
*photos on this post are of an actual pre-operative patient of Dr. Brenner.