Saddle nose deformity describes a condition where the bridge of the nose collapses, resulting in a sunken or concave appearance. This characteristic dip resembles a saddle, giving it its name. It alters the overall facial profile and can affect the nose’s proper functioning. This condition develops when the cartilage providing structural support to the nose breaks down.
Key Characteristics of Saddle Nose Deformity
The most noticeable feature is a visible depression along the nasal bridge. This concavity can range from a slight indentation to a severe collapse, making the nose appear flattened. In more pronounced cases, the nasal tip may turn upward, and the overall vertical length of the nose can appear shortened. This structural alteration can also lead to the retraction of the columella, the strip of tissue between the nostrils.
Healthcare providers classify saddle nose deformities into stages based on the extent of structural support loss. A minimal saddle nose presents with a small depression in the dorsal bridge, while a moderate deformity shows a larger depression and a flattened appearance from multiple angles. In severe cases, there is a significant lack of both bony and cartilaginous support, causing a pronounced sinking of the dorsum. These visual changes stem from damage to the nasal septum, the cartilage separating the nostrils, which is crucial for maintaining the nose’s shape.
Primary Causes of Saddle Nose
Saddle nose deformity often arises from nasal trauma. Injuries like fractures or blunt force impacts can damage nasal cartilage and septum, weakening the nose’s structural support and leading to bridge collapse. An untreated septal hematoma, a blood collection within the septum, can also disrupt blood flow to the cartilage, causing its disintegration.
Previous nasal surgeries, especially rhinoplasty or septoplasty, can also contribute to saddle nose development. If excessive cartilage or bone is removed without ensuring adequate structural support, the nasal bridge may become unstable and gradually collapse.
Certain medical conditions, including inflammatory diseases, can cause saddle nose deformity. Granulomatosis with Polyangiitis, an autoimmune disorder, causes inflammation that can destroy nasal cartilage and bone. Relapsing polychondritis, another autoimmune disease, involves recurrent cartilage inflammation throughout the body, including the nose, weakening its structure. Infections like syphilis and Hansen’s disease (leprosy) can also affect nasal bones and cartilage, leading to blood supply loss and subsequent collapse. Recreational drug use, such as snorting cocaine, can also damage nasal structures by constricting blood vessels and depriving cartilage of nourishment, resulting in a saddle nose.
Functional Impacts and Associated Issues
Beyond visible changes, saddle nose deformity can lead to various functional impairments and health concerns. The collapse of the nasal bridge often obstructs nasal passages, making breathing difficult through one or both nostrils. This can result in chronic nasal congestion, snoring, and obstructive sleep apnea. A whistling sound may also occur during breathing due to altered airflow dynamics.
Individuals with this condition may also experience chronic nasal crusting and recurrent nosebleeds. The noticeable changes in facial appearance can also impact self-esteem and confidence. Psychological effects like self-consciousness or anxiety may arise due to the altered facial profile.
Approaches to Correction
Correcting saddle nose deformity primarily involves surgical reconstruction to restore nasal structure and improve both appearance and function. Rhinoplasty procedures rebuild the nasal bridge, often using grafts to provide support and contour. Grafting material choice depends on the severity of the deformity and the amount of tissue needed.
Cartilage grafts are commonly harvested from the patient’s body, such as the nasal septum, ear, or rib. Septal cartilage is often preferred for smaller defects, while ear cartilage can be used for moderate cases. For severe deformities requiring substantial structural support, rib cartilage is frequently chosen due to its robust nature and ample supply. These grafts are shaped and placed to rebuild the collapsed areas, strengthen the nasal framework, and restore a natural profile. Synthetic implants may also be used to augment the nasal bridge.
For mild cases where the primary concern is cosmetic and no functional issues are present, non-surgical options like dermal fillers may be considered. Hyaluronic acid-based fillers can be injected into depressed areas of the nasal bridge to add volume and create a smoother contour. However, these results are temporary and require repeat treatments to maintain the effect. Dermal fillers cannot address underlying structural issues or improve breathing.