A saddle nose is a nasal deformity characterized by a concave or sunken appearance of the nasal bridge. This condition causes the middle part of the nose to sag, resembling a saddle. It involves a visible depression along the nasal dorsum, the length of the nose’s bridge.
Understanding Saddle Nose Anatomy
A saddle nose’s appearance results from a loss of structural support within the nasal framework. This deformity often presents as a flattened bridge, sometimes with an upturned nasal tip. The underlying cause is damage or weakening of the nasal septum, the cartilage and bone wall dividing the nostrils, or other supporting nasal cartilages. When these structures are compromised, the nose loses its height and projection, leading to the characteristic depressed look along the bridge.
Common Causes of Saddle Nose Deformity
Numerous factors contribute to saddle nose deformity. Trauma is a frequent cause, stemming from accidents, sports injuries, or blunt force impact that fractures nasal bones or damages cartilage and septum. A septal hematoma, a collection of blood within the nasal septum, can develop after injury, interfering with blood flow and leading to tissue damage. Unmanaged trauma may worsen over time, leading to indentation.
Systemic inflammatory diseases can also lead to cartilage degradation and nasal collapse. Conditions such as granulomatosis with polyangiitis, relapsing polychondritis, and lupus can cause vasculitis, reducing blood flow to the septum and resulting in tissue breakdown. Certain infections, including syphilis and Hansen’s disease, may affect bones and cartilage, leading to a lack of blood supply and sagging of the nasal bridge.
Repeated nasal surgeries, particularly rhinoplasty or septoplasty, can result in this deformity if too much cartilage or bone is removed without adequate structural support. Drug use, such as snorting cocaine, methamphetamines, or crushed opioid pills, can damage nasal structures due to vasoconstriction, leading to septal perforation and deformity. Less commonly, saddle nose can be present from birth due to congenital factors or conditions like Binder’s syndrome.
Beyond Cosmetic: Functional Concerns
A saddle nose deformity extends beyond cosmetic appearance, significantly affecting nasal function. The collapse of the nasal bridge can lead to breathing difficulties, as the compromised structure obstructs nasal passages. This obstruction can manifest as chronic nasal blockage or contribute to snoring.
Individuals may also experience crusting or bleeding inside the nose due to changes in airflow and mucosal health. The altered nasal anatomy can impair the sense of smell. Compromised drainage pathways within the nose can increase susceptibility to chronic sinusitis or recurrent infections. These functional issues can diminish an individual’s quality of life.
Approaches to Correction and Management
Diagnosis of a saddle nose deformity involves a physical examination; CT scans may be used to assess internal damage. Treatment aims to restore the nose’s cosmetic appearance and functional capabilities. Medical management of underlying systemic diseases, if present, is also important to prevent further progression.
Surgical reconstruction, primarily rhinoplasty, is the main method for correcting saddle nose. This surgery involves grafting cartilage or bone to rebuild the nasal bridge and provide structural support. Autogenous materials are preferred due to lower risks of infection and rejection. Common sources for these grafts include the nasal septum, ear cartilage, or rib cartilage. The choice of graft material depends on the deformity’s severity and the amount of cartilage needed.
For minor cosmetic concerns without significant functional impairment, non-surgical options like injectable dermal fillers can temporarily improve the nasal contour. These are temporary solutions and do not address underlying structural issues or functional problems. The goal of correction is to restore proper nasal anatomy, ensuring a natural appearance and improved breathing.