New and detailed classification of saddle nose deformities: step-by-step surgical approach using the current...

Currently, saddle nose deformity is one of the most challenging deformities in all of rhinoplasty surgery. Recent advances in aesthetic reconstructive surgical techniques warrant discussion of this subject.

A review of saddle nose cases from January 2003 to February 2007 showed that the existence of an important subgroup exists, designated as septal saddle nose deformity. The pathophysiology was weakening or loss of septal support, bone, or both, but not the classic dorsal overresection. A prospective study of 33 consecutive cases was completed, with emphasis on analysis, classification, and treatment.

Prior attempts at classification have emphasized cause. The author's study indicated that the majority of cases had multiple causes, the most common being trauma followed by septorhinoplasty (immediately or later), as opposed to simple fracture reduction. In addition, 23 of 33 cases were true secondary saddle nose deformities. Classification was divided into types. Different methods of composite reconstruction were devised according to each case and grade, which allows construction of a deep structural foundation layer that then is superimposed with an aesthetic layer.

Septal saddle nose still is an important entity that must be recognized and treated, especially when it is progressive. Composite reconstruction offers a unique solution to saddle nose deformity because it is a flexible method of restoring structural support and aesthetic contour.