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Original Investigation |

Treatment Outcomes of Saddle Nose Correction

Sang Min Hyun, MD1; Yong Ju Jang, MD1
[+] Author Affiliations
1Department of Otolaryngology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
JAMA Facial Plast Surg. 2013;15(4):280-286. doi:10.1001/jamafacial.2013.84.
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Published online

Importance  Many valuable classification schemes for saddle nose have been suggested that integrate clinical deformity and treatment; however, there is no consensus regarding the most suitable classification and surgical method for saddle nose correction.

Objectives  To present clinical characteristics and treatment outcome of saddle nose deformity and to propose a modified classification system to better characterize the variety of different saddle nose deformities.

Design, Setting, and Participants  The retrospective study included 91 patients who underwent rhinoplasty for correction of saddle nose from April 1, 2003, through December 31, 2011, with a minimum follow-up of 8 months. Saddle nose was classified into 4 types according to a modified classification.

Main Outcome and Measure  Aesthetic outcomes were classified as excellent, good, fair, or poor.

Results  Patients underwent minor cosmetic concealment by dorsal augmentation (n = 8) or major septal reconstruction combined with dorsal augmentation (n = 83). Autologous costal cartilages were used in 40 patients (44%), and homologous costal cartilages were used in 5 patients (6%). According to postoperative assessment, 29 patients had excellent, 42 patients had good, 18 patients had fair, and 2 patients had poor aesthetic outcomes. No statistical difference in surgical outcome according to saddle nose classification was observed. Eight patients underwent revision rhinoplasty, owing to recurrence of saddle, wound infection, or warping of the costal cartilage for dorsal augmentation.

Conclusions  We introduce a modified saddle nose classification scheme that is simpler and better able to characterize different deformities. Among 91 patients with saddle nose, 20 (22%) had unsuccessful outcomes (fair or poor) and 8 (9%) underwent subsequent revision rhinoplasty. Thus, management of saddle nose deformities remains challenging.

Level of Evidence  4.

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Figures

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Figure 1.
Classification of Saddle Nose Deformity

A, Type 1 has minor supratip or cartilaginous dorsal depression. B, Type 2 has moderate to severe cartilaginous dorsal depression, with a prominent lower third. C, Type 3 has pan-nasal defect with severe bony dorsal deficiency, in combination with a lower third deficit. D, Type 4 has pan-nasal defect and a relatively prominent tip projection only by the lower lateral cartilage.

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Figure 2.
A 21-Year-Old Woman With Type 1 Saddle Nose Deformity Treated With a Caudal Septal Extension Graft and Dorsal Augmentation With Fascia Lata and Crushed Cartilage

A, Preoperative lateral view; B, 48-month postoperative lateral view.

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Figure 3.
A 55-Year-Old Woman With Type 2 Saddle Nose Deformity Treated by Extracorporeal Septoplasty Using Autologous Costal Cartilage

A, Preoperative lateral view;

B, 24-month postoperative lateral view.

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Figure 4.
A 21-Year-Old Woman With Type 3 Saddle Nose Deformity Treated by a Bilateral Extended Spreader Graft and a Caudal Septal Extension Graft With Autologous Costal Cartilage

A, Preoperative lateral view; B, 24-month postoperative lateral view.

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Figure 5.
A 33-Year-Old Man With Type 4 Saddle Nose Deformity Treated by Extracorporeal Septoplasty Using Autologous Costal Cartilage

A, Preoperative lateral view; B, 5-month postoperative lateral view.

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Figure 6.
Three Different Methods for Septal Reconstruction

A, One extended spreader graft was sutured on one side of the existing L-strut, and one caudal septal extension graft was placed contralaterally. B, Bilateral spreader grafts and 2 batten grafts were sutured on the both sides of the existing L-strut. C, Bilateral extended spreader grafts were placed on both sides of the existing L-strut, and one caudal septal extension graft was sandwiched between them.

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Figure 7.
Unsuccessful Outcomes According to Type of Saddle Nose

Occurrence of unsuccessful outcomes was lowest in type 3, but there was no statistical significance according to the saddle nose classification (P = .33).

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