Refinements in Saddle Nose Reconstruction

Abstract

Saddle nose correction remains a challenging procedure for rhinoplasty surgeons due to both aesthetic and functional issues. The most common causes of saddle nose are nasal trauma and prior septal surgery, and a defective relationship between the caudal septum and the anterior septal spine is the principal postoperative pathology. The authors propose their own classification system for saddle nose with one new category and several approaches to deal with this condition in accordance with the level of severity. They strongly advocate major septal reconstruction for most cases of saddle nose, either by placing extended spreader grafts, caudal extension grafts, or a new extracorporeally made L strut. For extreme cases, integrated dorsal implant with columellar strut can successfully bypass the saddled nasal dorsum without dissecting the septal mucoperichondrial pocket and achieve adequate dorsal height. Further dorsal augmentation can be achieved by applying side/gap grafts or dorsal onlay grafts in different forms. In cases with retracted columella, a premaxillary plumping graft is another useful technique. Finally, in autoimmune-related saddling patients, the evidence indicates that their aesthetic problems can be managed safely with surgery as long as the disease is well under control.

Effectiveness of modified cutting and suture technique for endonasal caudal septoplasty in correcting nasal obstruction and preventing nasal tip projection loss

“…However, fibrous attachment of the lower lateral cartilage to the septal cartilage and the intercrural ligament is important for nasal tip support [ 8 ]. Instability or breakage of the keystones leads to saddle nose deformity [ 11 ]. Therefore, important structures such as the lower lateral cartilage and keystone area should be preserved as much as possible.…”

Septal Reconstruction With Folded Porous Polythylene Implants: An Alternative Technique for the Correction of Severe Saddle Nose Deformities in Asian Populations

“…Hence, a reliable septal reconstruction is recommended for septum, tip support restoration and internal valve optimization by both Western and Eastern plastic surgeons. 6,24 Hereby, we developed an alternative technique to accomplish extended spreader graft and septal extension graft with one folded Medpor simultaneously. The two folded sheets served as conventional spreader grafts by sutured bilaterally between the septum and ULC.…”

“…Owing to the roofed structure at the top of the graft, delicate dorsal aesthetic lines could be naturally recreated without formation of tissue void or flaring at dorsum, which is particularly common for conventional spreader graft. 6 In this study, we used AT/RT ratio for the objective evaluation of aesthetic issues. AT/RT is a relative parameter which highly correlates with nasal dorsum and tip projection.…”

Special Consideration in the Management of Hump Noses in Asians

“…8). 13 Additional tip grafting is required when tip projection using a caudal septal extension graft cannot achieve the desired height in moderate to thick-skinned individuals (►Fig. 9).…”