Saddle nose deformity: pathological grading and anatomical reconstruction

Abstract

Importance: Management of saddle nose deformity needs to be directed toward diagnosing its etiology and its treatment. Objective: The aim of this study was to propose a simple classification system for saddle nose deformity that depends on pathologic grading and anatomic reconstruction. Setting: This study was conducted at a university-affiliated tertiary hospital. Study design: The study design was a retrospective chart review. Patients and methods: Patients with saddle nose deformity presenting from 2012 to 2014 were reviewed. The patients were classified according to the septal condition as follows: grade 1, saddle nose due to pathology other than septal collapse (dorsum over-resection, familial, or racial); grade 2, septum is collapsed but can be fixed by means of bone grafts or septal replacement grafts; and grade 3, patients need cartilaginous septum reconstruction. Results: The study included 32 patients, 20 female and 12 male, with a mean age of 27 years. Eleven cases were of grade 1 and were managed with dorsal grafts (septal cartilage in two, conchal cartilage in two, and diced cartilage in fascia in seven cases). Sixteen cases were of grade 2, and all were post-traumatic primary cases. Bone grafts to straighten and stabilize the broken septum were used in 13 cases, and septal replacement grafts were used in three cases. Five cases were of grade 3 and required replacement of septal L-strut that was concealed with diced cartilage in fascia. Columellar strut was used in all cases. Conclusion: Diagnosis and management of saddle nose deformity should depend on identifying the etiology of each case and classifying them into cases due to correctable septal pathology that can be managed with straightening the septum, or those due to missing septum that need septal reconstruction, and those due to low dorsum without septal pathology that can be simply corrected with dorsal grafts. Using this anatomical approach we are trying to achieve a strong esthetic pleasing functioning nose.