Severe saddle nose deformity reconstructed with rib cartilage

Augmenting the nasal dorsum is often a difficult task, because of the irregularities that might be visible under the thin dorsal nasal skin. Saddle noses are especially difficult to correct because of the need to provide strong structural support to the nose while at the same time achieving an aesthetic dorsum. Stable reconstruction of the cartilaginous septum is the critical challenge in the operative treatment of such deformities with both functional and morphological implications. Treatment depends on the degree of saddling. Autologous cartilage is widely recognized to be the standard against which other materials must be judged. It is the most acceptable and reliable long-term graft. We present a case of unusually severe posttraumatic saddle nose resolved with a single rather large costal cartilaginous graft and a columellar strut. Classic extended spreader grafts could not be used due to the lack of bony and cartilaginous support of the nasal pyramid and, thus, no possibility of stabilization. A normal nasal dorsum, as well as breathing improvement, were achieved and the patient was extremely satisfied with the result. We had no complications except a slight asymmetry of the nostrils. Graft resorbtion or displacement was not observed on the 14-months follow-up.