Treatment Outcomes of Saddle Nose Correction

Abstract

addle nose deformity results from disruption of bx;1the baseptal support and is characterized by middle vault depression and widening, columellar retrusion, tip overrotation, deprojection, and nasal shortening. 1 Nasal obstruction caused by collapse of the upper and lower cartilages is also a frequent finding. 2 Saddle nose is a common deformity encountered in rhinoplasty, yet it remains one of the most challenging deformities to treat. 3 Although several articles 2,4,5 that introduce surgical techniques for saddle nose correction are available, few articles address the surgical outcomes and difficulty of saddle nose correction.Many valuable classification schemes for saddle nose have been suggested that integrate clinical deformity and treatment, including those by Vartanian, 6 Tardy et al, 7 and Daniel and Brenner. 8 Overall, there is no consensus regarding the most suitable classification and surgical method for saddle nose correction. In our rhinoplasty practice for Asian nose, we identified many patients whose saddle noses do not fit exactly into the classification systems proposed previously. Therefore, we developed a modified saddle nose classification to supplement the limitations of previous classifications.The present study retrospectively analyzed 91 patients with saddle nose for cause, treatment methods, and aesthetic outcomes, according to a modified classification scheme. This study could provide insight into the management of saddle nose for rhinoplasty surgeons. IMPORTANCE Many valuable classification schemes for saddle nose have been suggested that integrate clinical deformity and treatment; however, there is no consensus regarding the most suitable classification and surgical method for saddle nose correction. OBJECTIVES To present clinical characteristics and treatment outcome of saddle nose deformity and to propose a modified classification system to better characterize the variety of different saddle nose deformities. DESIGN, SETTING, AND PARTICIPANTS The retrospective study included 91 patients who underwent rhinoplasty for correction of saddle nose from April 1, 2003, through December 31, 2011, with a minimum follow-up of 8 months. Saddle nose was classified into 4 types according to a modified classification. MAIN OUTCOME AND MEASURE Aesthetic outcomes were classified as excellent, good, fair, or poor.RESULTS Patients underwent minor cosmetic concealment by dorsal augmentation (n = 8) or major septal reconstruction combined with dorsal augmentation (n = 83). Autologous costal cartilages were used in 40 patients (44%), and homologous costal cartilages were used in 5 patients (6%). According to postoperative assessment, 29 patients had excellent, 42 patients had good, 18 patients had fair, and 2 patients had poor aesthetic outcomes. No statistical difference in surgical outcome according to saddle nose classification was observed. Eight patients underwent revision rhinoplasty, owing to recurrence of saddle, wound infection, or warping of the costal cartilage for dorsal augmentation.CONCLUSIO...

Complications and Treatment of Delayed or Inadequately Treated Nasoorbitoethmoid Fractures

“…Characteristically, the saddle nose deformity is caused by a loss of nasal support resulting in a loss of nasal projection, nasal shortening, tip overprojection, and middle vault flattening. 5 Not only do these injuries have potentially devastating aesthetic repercussions, but they also have functional implications as well. Therefore, any repair must attempt to restore nasal projection and alleviate symptoms of nasal obstruction.…”

Dorsal Augmentation in Facial Profiloplasty

“…9). 7,10 The authors prefer to augment the damaged septum using bilateral extended spreader grafts made of costal cartilage to sandwich each caudal septal extension graft. If the caudal septum is very weak and deviated, the extension graft can be placed in a side-to-side position.…”

Refinements in Saddle Nose Reconstruction

“…Postoperative complications are sometimes seen following a saddle nose correction, including infection, incomplete correction and recurrent saddling, scarring of the transcolumellar incision, secondary nasal deformity related to dorsal augmentation materials, and donor-site morbidity. 10 No matter which method or material is chosen, meticulous and aseptic surgical techniques are fundamental to every successful surgery. Avoiding mucosal defects during dissection and frequent saline irrigation are very important for decreasing the postoperative infection rate.…”