Saddle nose is a condition characterized by a noticeable collapse or depression in the bridge of the nose. This “saddle-like” appearance results from a loss of structural support within the nasal framework, affecting both appearance and breathing.
Understanding Saddle Nose
Saddle nose presents as a dip or concavity along the nasal dorsum. This sunken appearance can range from a slight indentation to a severe collapse. The condition gets its name from its resemblance to a horse’s saddle.
The physical changes involve the cartilaginous and/or bony structures that provide the nose with its shape and support. The nasal septum, a wall of cartilage and bone separating the nostrils, maintains nasal height and projection. When this septal support is compromised, the middle portion of the nose can sag, leading to the deformity.
Causes of Saddle Nose
Saddle nose develops from damage to the supporting structures within the nose. Trauma is a common cause, with injuries like sports accidents or physical altercations potentially fracturing or disrupting nasal cartilage and bone. An untreated septal hematoma, a collection of blood within the septum after trauma, can also interfere with blood flow, leading to cartilage breakdown.
Previous nasal surgeries, especially rhinoplasty that removes excessive cartilage, can weaken the nasal framework, resulting in collapse. Septoplasty to correct a deviated septum can also contribute if not performed carefully. Autoimmune diseases like granulomatosis with polyangiitis and relapsing polychondritis are linked to saddle nose. These conditions cause inflammation that can destroy nasal cartilage, leading to progressive collapse of the nasal bridge.
Infections like syphilis, leprosy, and tuberculosis can affect nasal bones and cartilage, leading to structural damage. Prolonged use of substances like snorting cocaine can also cause severe damage by constricting blood vessels, leading to tissue death and eventual collapse of the nasal septum.
Recognizing Saddle Nose
Saddle nose is identified by physical changes in the nasal bridge. Beyond the visible depression, individuals may experience functional symptoms. These include difficulty breathing through the nose, chronic crusting inside the nostrils, recurrent nosebleeds, a diminished sense of smell, or a whistling sound when breathing.
Diagnosis involves a physical examination where a healthcare provider assesses the depression and nasal structure. A detailed medical history is taken, inquiring about past nasal traumas, surgeries, or underlying medical conditions. Imaging studies like CT scans or blood tests may be performed to evaluate damage and identify systemic causes.
Treatment Approaches
Treatment for saddle nose focuses on restoring nasal function and aesthetic appearance. Surgical intervention, often through reconstructive rhinoplasty, is the most common and effective approach. This procedure rebuilds the collapsed nasal bridge and provides structural support.
During reconstructive rhinoplasty, surgeons use cartilage grafts to augment the nasal dorsum and reinforce weakened structures. Grafts are harvested from the patient’s own body, such as the nasal septum, ear cartilage, or rib cartilage. Spreader grafts are strategically placed to widen the internal nasal valve, improving airflow and preventing collapse. The goal is to create a stable, natural-looking nasal contour while addressing breathing difficulties.
For very mild saddle nose, non-surgical options may be considered. Dermal fillers can be injected into the depressed area to temporarily raise the nasal bridge and improve its contour. This non-invasive method offers immediate results and can last for several months to over a year, depending on the filler type. However, fillers provide a temporary solution and do not correct underlying structural issues or functional breathing problems.