Saddle Nose

Saddle nose is a condition associated with nasal trauma, congenital syphilis, and relapsing polyarthritis coupled with polyangiitis, cocaine abuse, and leprosy among others. A nasal fracture is one of the most common causes of nose deformities. It can lead to a loss of nasal height, due to the collapse of the nasal bridge. The nasal dorsum of the nose can lose either, or both, it’s bony and cartilaginous components.


Saddle Nose causes:

Saddle nose is caused by erosion and perforation of the nose caused by trauma or complications during nasal surgery. Habitual use of cocaine or inhaling other drugs may also cause damage to the cartilage and septum of the nose. In some cases, saddle nose is caused by chronic nasal inflammation caused by Wegener’s Granulomatosis. It may also be caused by an inherited or genetic disorder such as:

  • Congenital syphilis
  • Relapsing polychondritis
  • Down syndrome

Common causes:

  • Nasal Trauma: When the septal cartilage of the nose is damaged, it compromises important support structures, especially in sports with extreme physical contact, like boxing and hockey. Athletes are especially vulnerable to this type of injury. An impaired blood supply can impair bone regrowth, resulting in the weakening of cartilage.
  • Surgical Causes: Attempts to reduce the height of the nose bridge with excessive cartilage removal can contribute to excessive cartilage being removed following rhinoplasty surgery. There may no longer be sufficient bone and cartilage which can result in the collapse of the middle portion of the nasal bridge.
  • Intranasal Cocaine Usage: Vasoconstriction caused by cocaine causes the blood vessels to narrow. This causes the nasal septum’s cartilage to deteriorate to such an extent that a hole forms in the septum. Those who stop using cocaine before permanent damage is caused can have their blood vessels rebuilt. When cartilage is perforated, however, it can not be repaired by itself.

 

Deformity of the saddle nose and its correction:

There is no specific disease that causes saddle nose deformity. Symptoms of a deviated nose result from the damage to the septum, which supports the nose.

This lack of support produces a typical concavity to the bridge of the nose inside (profile) view – like the shape of a horse’s saddle, hence the term ‘saddle nose deformity’. This deformity leads to progressively increased breathing difficulties for the patient, and it is a very distressing appearance for most people.

 

Any process that weakens the septum can lead to saddle nose deformity:

  • The septum is over-resected or removed in poorly performed septoplasty or rhinoplasty
  • Cocaine damage to the septum of the nose
  • Avascular disease that weakens the septum by causing inflammation
  • There are large perforations on the nasal septum

A rib cartilage graft or an ear cartilage graft is used to rebuild the septum to re-support the midportion of the nose. The saddle may be corrected with cartilage grafts from the ear or the ribs.

 

Causes of Cocaine Nose Injury involve:

The first and most important step to a successful reconstruction is to stop any cocaine use. If the patient continues to snort cocaine, then reconstructive surgery will not be successful.

There are many similarities between a cocaine nose injury and the process of the vasculitic nose. In fact, there is a possibility that cocaine itself may result in a vasculitic process occurring on the nose that continues well after the patient stops snorting cocaine.

This condition is manifested by changes in the mucosa, stuffiness, crusting, and occasional pain in the nose. These are signs of cocaine usage.

Due to the cycle of inflammation and healing caused by cocaine use, the cartilage in the septum weakens secondary to the inflammation, leading to a perforation (hole) in the septum.  

In the case of progressive septal damage, the saddle deformity can worsen, causing the tip of the nose to rotate upward as well as become shorter.

As the inflammation cycle continues and healing occurs, the nasal inner lining is further damaged and shrinks from scarring, resulting in further shortening of the nose. 

Continual use of the nose can erode the columella (the bar of skin between the nostrils). Click here to see a columella reconstruction after cancer treatment.

The end result is a nasal collapse due to deficiencies in the inner lining of the nose as well as the cartilage framework.

 

Treatment of Saddle Nose:

It may not be necessary to treat saddle nose if it does not cause a functional problem with the nose. When saddle nose causes difficulty breathing and decreased nasal function, surgery may be necessary. Surgery for saddle nose may also be performed for cosmetic reasons. Surgical procedures for saddle nose may include:

 

  • Septal Perforation Repair Surgery:

The doctor may also perform septal perforation repair surgery if the saddle nose includes a septal perforation. This would require removing tissue from inside the nose to fill in the septal hole. A tissue flap may also be created to repair the perforation. If the perforation is large, then it may be difficult to repair, which is why it is sometimes closed with a button made of silicone plastic, which snaps together to cover both sides.

  • Rhinoplasty:

This procedure involves lifting the skin of the nose, sculpting the bone and cartilage, and adding to the nose cartilage or bone taken from another place on the body, such as the rib or of the ear. and Replacement of skin and stitching up of the wound. 

Some doctors can use medical liquid silicone as an alternative to surgery to correct deformities or to fill grooves in the nose. Depending on the individual’s condition and needs, a doctor will design a unique treatment plan for the saddle nose.