Saddle nose deformity is characterized by a noticeable depression or collapse of the nasal bridge, affecting both the appearance and function of the nose. This structural abnormality is named for the sunken, concave profile that resembles a saddle. The condition often raises concerns about breathing difficulties alongside cosmetic issues. Whether the deformity will worsen over time is a primary concern, and it depends entirely on the initial cause of the collapse. This article explores the anatomy, underlying conditions, and factors that determine the stability of saddle nose.
Anatomy of Saddle Nose Deformity
The characteristic depression of a saddle nose results from a loss of support in the middle third of the nose. This area relies heavily on the nasal septum, a wall of cartilage and bone that divides the two nasal passages and acts as a central supporting pillar. When the cartilaginous part of the septum is damaged, its structural integrity is compromised, leading to a collapse of the overlying nasal dorsum, or bridge.
The progressive loss of septal integrity causes a visible depression and splaying of the mid-vault, which is the middle section of the nose. This structural failure can also cause the nasal tip to lose vertical projection and rotate upward, a feature sometimes described as a “pug nose”. Functionally, the collapse often affects the internal and external nasal valves, which are crucial for regulating airflow, leading to significant breathing difficulties and obstruction.
Underlying Conditions That Cause the Collapse
The destruction of nasal cartilage that causes saddle nose deformity stems from several distinct etiologies. Blunt force trauma is a frequent cause, where a fracture or a septal hematoma (a collection of blood under the cartilage lining) disrupts the blood supply. This disruption leads to tissue death and collapse. If a septal hematoma is not promptly drained, it can progress to an abscess, causing rapid cartilage necrosis.
Systemic diseases, particularly autoimmune and inflammatory disorders, are also significant causes. Granulomatosis with Polyangiitis (formerly Wegener’s granulomatosis) is an autoimmune condition that specifically attacks and destroys nasal cartilage. Other conditions, such as relapsing polychondritis, also target cartilage and can lead to nasal collapse. Certain infections, including syphilis and Hansen’s disease (leprosy), can erode the nasal septum and result in this deformity.
Previous nasal surgeries, such as aggressive rhinoplasty or septoplasty, can inadvertently weaken the nasal structure if excessive cartilage is removed or if the remaining support is inadequate. Chronic intranasal drug use, particularly cocaine, causes severe vasoconstriction, reducing blood flow to the nasal tissues. This lack of blood leads to ischemia and necrosis, resulting in a perforated septum and progressive collapse of the nasal bridge.
Determining the Stability of the Deformity
The question of whether a saddle nose deformity will worsen is directly linked to the activity level of the underlying cause. If the damage resulted from acute trauma, such as a resolved fracture or a treated septal hematoma, the deformity is generally considered stable once healing is complete. In these cases, the collapse has reached its maximum extent, and further progression is unlikely.
Conversely, the deformity will likely continue to progress if the root cause is an ongoing, untreated systemic disease or continued substance use. Active autoimmune vasculitis, like Granulomatosis with Polyangiitis, will continue its inflammatory destruction of cartilage unless medically managed. Continued use of vasoconstrictive drugs like cocaine will also lead to further tissue damage and a deepening of the collapse. Medical evaluation is paramount to determine stability and rule out active disease before any reconstructive surgery is attempted.
Surgical and Non-Surgical Correction
Once a medical evaluation confirms the underlying condition is stable and non-progressive, repair of the nasal structure can be planned. The definitive treatment for saddle nose deformity is surgical reconstruction (rhinoplasty), which aims to rebuild the nasal framework and restore both form and function. The procedure involves using grafting materials to augment the nasal dorsum and provide septal support.
For moderate to severe collapse, surgeons frequently use autologous cartilage grafts—tissue taken from the patient’s own body, often from the rib or ear. Rib cartilage is a common choice for significant structural defects due to its robustness and ability to provide the necessary framework. Non-surgical options, such as injecting dermal fillers, are available for minor deformities where only a slight depression needs to be filled. These fillers, typically hyaluronic acid-based, offer a temporary correction but cannot provide the structural support required for extensive collapse.