Management of post-traumatic combined deviated and saddle nose deformity

Establishing a straight and firm septum supporting the overlying nasal structures is the most important step in correcting the post-traumatic combined deviated and saddle nose.

To present a surgical algorithm and key maneuvers that were successfully applied in the correction of post-traumatic combined deviated and saddle nose deformity.

Twenty-five patients who had undergone primary rhinoplasty for a post-traumatic combined deviated and saddle nose were included. The patterns of deformity, surgical maneuvers, surgical results, and complications were analyzed using retrospective chart review, telephone interview, and preoperative and postoperative photographs.

Three distinct groups undergoing different techniques to correct the deformity were noted. Eighteen patients (72%) with intact septal support were treated by straightening the nose and septum followed by simple onlay grafts. Five patients (20%) with loss of septal support needed septal reconstruction. In two patients (8%) showing deviation, generalized saddling, and loss of septal support, a dorsal graft integrated to an extended columellar strut was performed, bypassing the major septal reconstruction. The key maneuvers for correction were dorsal onlay graft (100%), septoplasty (92%), and bilateral osteotomies (84%). No major complications were found. Objective evaluation showed complete correction of the deviation and saddling in 76%.