Saddle Nose Deformity

A saddle nose deformity occurs when the bridge has an externally visible concavity that gives it a ‘saddle’ effect and loss of height. This saddle effect is most common in the cartilaginous portion of the bridge above the nasal tip. This bridge concavity is essentially the opposite problem encountered in a pollybeak deformity.

The saddle nose deformity also leads to loss of cartilage support in the area of the saddle and can also lead to an overly up turned tip or loss of tip support.

What causes a saddle nose deformity?

A saddle nose deformity comes from the loss of nasal cartilage support. This loss of cartilage is usually from the septum but can also be from the upper lateral cartilages. There are a number of causes. We have explored some below.

Saddle nose deformity from nasal fracture

Nasal trauma can cause a saddle nose deformity if a blood clot forms under the septal skin lining. This disrupts your normal blood supply to the cartilage which if left untreated can cause the cartilage to disintegrate. If this damage is located high towards the bridge of the nose the skin in that area can collapse down given the lack of support.

Medical problems that can cause a saddle nose deformity

There are a number of uncommon medical conditions that can cause a large hole in the nasal septum and then a saddle nose. These include Wegener’s granulomatosis, relapsing polychonditis and syphilis. Your surgeon may order a blood test to confirm that you do not have one of these conditions.

Saddle nose deformity from a previous septoplasty or rhinoplasty

Unfortunately some times when a septoplasty or rhinoplasty is performed too much septum is removed or inadequate support is constructed. This can lead to the septum dropping inwards and causing a saddle nose deformity. This is more likely if the original bend in the septum is more severe.

How is a saddle nose deformity fixed?

Typically the nasal septum needs to be elevated and secured with spreader grafts to the upper lateral cartilages. An alternative is an onlay graft placed into the defect area. Sometimes this graft needs to be taken from the ear. If large septal perforation is also present, attempts should be made to try and close this. A very severe saddle nose deformity may require a rib graft to provide the needed support.