Saddle noses is caused by conditions that weaken or perforate the nasal septum including prior septoplasty, botched rhinoplasty, recreational drug use, medical conditions such as granulomatosis with polyangiitis (Wegener’s granulomatosis), congenital syphilis and trauma.
The depressions of the nasal dorsum can be located in its bony portion, the cartilaginous segment or across osteocartilaginous extension, constituting the saddle nose itself.
Main Causes of Saddle Nose include:
- Congenital malformations (Congenital) appear in the fetus after birth. There are congenital cases as a result of exposure of pregnant women to external factors of different praise the first months of pregnancy or childbirth.
- Genetic factors (Hereditary factors) have a big nose or either a small or missing nose or mushroom nose.
- Drug abuse. Cocaine addicts also have high tendency of having saddle nose deformity along with those who underwent a surgery of the nose.
- Floral sexually transmitted diseases (Venereal diseases) that may infect the mother and passed on to the fetus and thus lead to deformation of the nose (saddle nose) such as a saddle horse.
- Leprosy (leprosy) of infectious diseases which lead to the nose and eat Choha.kzlk tuberculosis skin or skin tuberculosis (lupus vulgaris).
Cancerous tumors (Malignant tumors), for example, Laura M. basal cells that infect the skin.
- Previous nose surgery: Surgeries of the nose such as reductive rhinoplasty may result in damage to the bones that support the nose.
- Traffic accidents and fights when boxers, may lead to fractures in the bones of the nose with distorted.
- Inflation fatty skin glands and others in the private adult (rhinophyma) lead to inflation nose abnormall
Saddle nose is divided into three kinds of simple and complex, according to their degree can be divided into mild, moderate, and severe:
- Mild: mild nasal collapse, slightly flattened and wide nasal dorsum, micro-pits or radians unnatural.
- Moderate: obvious nose collapse, bridge of the nose section width, two nose in the air, the nasal tip and nasal short stay flat, shorter length of the nose.
- Severe: severe depressed nasal dorsum, nose and accompanied by obvious external nasal structure, nasal septum and nasal deformity.
The proposed treatment strategy is based on detailed analysis of the clinical signs, resulting in a graduated solution adapted to each clinical case according to the severity of the deformity.
Other Causes of Saddle Nose Include:
Syphillis and Saddle Nose
Syphilis is another condition that can lead to a saddle nose. Saddle nose syphilis is found in adults who got it from their mothers while they were still in the womb.
An unborn child in the womb contracts this type of syphilis from the mother suffering from this infection. If the pregnant woman has syphilis during pregnancy can pass the disease to the child through the placenta. This can also happen through contact with the vaginal canal during delivery.
Untreated congenital syphilis can cause the bridge of the nose to collapse and the flesh around it to rot away in what’s called a saddle nose deformity.
Alexander Fleming discovered an effective treatment, penicillin , in 1928, having saddle nose became a mark of shame that marked its victims as morally corrupted.
Mothers should be thoroughly screened during pregnancy to treat any signs of syphilis as it can lead to major complications in the baby and adult.
Abnormal genes that parents are passed to the children cause genetic diseases. These disorders can not be cured. The following genetic disorders can cause the lower nasal bridge.
The cleidocranial dysostosis causes the skull and collarbone of the person to develop abnormally. Some people with cleidocranial dysostosis may have low nasal bridge.
Williams Syndrome Saddle Nose
Williams syndrome is a developmental disorder that affects many areas of the body. It is caused by a deletion of genetic material from chromosome 7. The excluded material includes more than 25 genes.
People with Williams syndrome have mild to moderate intellectual disability, developmental delay, and distinctive facial features. Williams syndrome also causes bone deformities such as low nasal bridge.
Treatment: Minimal saddle nose is treated by extracorporeal rhinoplasty, an inverted U-shaped conchal graft is used to treat moderate saddle nose, and costal cartilage was used to reconstruct major saddle nose.
Some patients may also experience saddle nose from genetic disorders like Wegener’s granulomatosis or Sarcoidosis, but these conditions are rare.
Although Wegener’s granulomatosis typically involves the upper and lower respiratory tracts and the kidneys, can affect any organ system. Presentations include fever, arthralgia, nasal stuffiness, nosebleeds, rhinitis, collapse of the nasal bridge (the aforementioned saddle knows deformity), and rapidly progressive renal failure.
Wegener’s granulomatosis can cause destruction of cartilage over time. Patients with Wegener’s granulomatosis develop a saddle nose deformity with destruction of the dorsal nasal cartilage. The destruction is caused by the immune cells may accumulate around the blood vessels that supply to the nose.
Bacterial infection can cause Wegener’s-related sinusitis (inflammation of the sinuses) with congestion and chronic sinus pain. Nearly half of people with Wegener’s granulomatosis develop skin lesions. The lungs are affected in most people with Wegener’s granulomatosis, although no symptoms may be present.
In certain forms of vasculitis, such as granulomatosis with polyangiitis (Wegener’s granulomatosis), the nasal cavity is frequently affected. Other nasal complications in Wegener’s granulomatosis include perforated nasal septum, mucosal ulceration, epistaxis, and boggy nasal turbinates with purulent nasal discharge.
Wegener’s granulomatosis usually affects young or middle-aged adults. The disease is predominantly seen in Caucasians, with an sense, varying from 8.5 to 30 cases per million babies born. Still, no race or age group is immune, and males and females are equally affected.
Treatment: Steroid medications may be given to treat conditions such as Wegener Granulomatosis or Relapsing Polychondritis that may result in Saddle Nose. The option for a medical treatment is raised and applied only when the goal of the treatment is to stop or prevent the disease progression like in cases of Wegener granulomatosis.
A more specific blood test used to diagnose and monitor Wegener’s granulomatosis is the antineutrophil cytoplasmic antibody (ANCA test), which is commonly elevated when the disease is active.
Wegener granulomatosis is characterized by necrotizing granulomas and vasculitis of the upper and lower respiratory tracts, including the nasal septum. Abnormal lab findings in patients with Wegener’s granulomatosis include urine tests that detect protein and red blood cells in the urine (not visible to the naked eye) and x-ray tests of the chest and sinuses which detect abnormalities resulting from lung and sinus inflammation.
Down’s syndrome Saddle Nose
Down syndrome is caused by trisomy 21. This means that every cell of the body has three copies of chromosome 21 instead of the usual two copies. People with Down syndrome have mild to moderate intellectual disability, developmental delay and unusual facial and body features, including face flat or round face and also low nasal bridge.
In this process a partial lifting of the bones and cartilage of the nose and at the discretion of the doctor in charge, the spectrum through the wound is virtual in Mnachr nose under local or general anesthesia depending on the severity of the situation and the amount of deformation.
Fetal alcohol syndrome (FAS)
The SAF is a group of birth defects that the child may have when the mother consumed alcohol during pregnancy. The chances of SAF are higher when the mother consumes alcohol during the first trimester of pregnancy.
This syndrome causes problems in the nervous system, growth deficiencies, behavioral problems, learning disabilities and facial abnormalities such as low nasal bridge.
Choanal atresia Saddle Nose
Choanal atresia, which arose immediately after birth, is a consequence of incomplete resorption of mesenchymal tissue in the embryo. In the future, it hardens, turning into bone and connective tissue. Bilateral atresia can lead to infant death. With such a diagnosis a person has no reflex to open his mouth and breathe.
This deformity may be partial, and is expressed in the wrong formation of the facial skeleton, upper front teeth. Determination of this diagnosis is performed by sensing procedure, water is poured in through the nostrils using a catheter. If a person is diagnosed with a complete atresia, all liquid will pour back.
Treatment: Septoplasty, with or without turbinate reduction, is perhaps the most common surgical procedure to address persistent nasal obstruction. Simple submucosal resection of bony or cartilaginous deviations of the midseptum is a technically uncom-plicated and highly successful operation.
Trauma and Saddle Nose
The main cause of the nose and the nasal septum saddle is a mainstay of the devastation caused by the nose, or combined factors in addition to the inner wall of the injury to the nasal mucosa scar contraction exists.
The saddle nose may be the result of a trauma followed by septal abscess. It is considered as etiological factors of the saddle nose, infections such as leprosy, syphilis, tubers and blastomycosis.
Noteworthy are also the iatrogenic causes, originating primarily from the consequences of the naso-frontal-orbital surgery (2). According to Villela, the craniofacial traumas leave as sequel depressions in the nasal dorsum called saddle nose that cause injury to the inner corner Orbit, occurring telecanthus. The lacrimal system can be compromised leading to dacryocystitis.
There are two kinds of congenital and acquired. Acquired mostly from trauma, infection or surgery caused the collapse of the bridge of the nose. Simple, skin and mucous membrane of the nose sound, not weakness.
In addition to the complexity of those sunken nose, the nose is still integrating the outer skin and mucous membrane of the nose, nasal defect or scar contraction.
What we can do to make things fair for them is work to end abuse, educate people about proper care and treatment, study treatments for injury and illness to alleviate suffering, work to end bad situations so that it doesn’t cause harm or discomfort.
HYPOPLASIA of the maxilla may cause a facial malformation is characterized by saddle nose, shortening of the columella, flattening of the alar flares, and depression of the malar eminences.
Trauma, intrinsic infection, tumor, or ex-trinsic factors may alter the growth or po-sition of the facial bones. There are two reports in the literature of maxillary hypo-plasia following forceps delivery.
Mal-occlusion, if part of the condition, may be corrected by orthodontics or by surgical re-location of the maxilla or mandible. Kaz-anjian, however, has limited this procedure to patknts with maxillary fracture.’
Diagnosis of Saddle Nose
During your rhinoplasty consultation the doctor will review your treatment options for facial cosmetic surgery, primary and secondary rhinoplasty, Septoplasty, repair of nasal fracture, and reconstructive nose surgery, including pros and cons of each procedure, rhinoplasty cost and prices, pre and post-operative instructions, and esthetic outcomes.
Medical attention is needed so that doctors can find septal hematomas, cerebrospinal fluid leaks, and other facial injuries that may need to be treated right away. Consulting to a rheumatologist is essential because they know the treatment process and how to avoid further damage to the nasal cartilage.
Specialists who can diagnose a saddle nose are:
- Plastic surgeon.
A good reconstructive plastic surgeon will take the time to examine your needs and your medical history and will explain the best options for a corrective procedure that will alleviate your symptoms and leave you looking and feeling your best.
Be prepared for the query can facilitate diagnosis and optimize time. This way, you can now get to the consultation with some information:
- A list of all the symptoms and how long they appeared
- Medical history, including other conditions the patient has and medications or supplements he takes regularly
- If possible, ask for a person to accompany you.
X-rays of the nose are not normally done because they are not accurate for diagnosing fractures or helpful in indicating what treatment is necessary.
Sam Rizk, who specializes in rhinoplasty in NYC, recommends a detailed examination of the nose and getting a detailed history which will enable the surgeon to determine the cause of an established saddle nose deformity, which should help in the planning of the corrective procedure.
Symptoms of Saddle Nose
Aesthetically, nasal septa irregularities can result in twisting of the nose, dorsal humps or depressions, and underprojection. The caudal septum provides a unique set of challenges to the rhinologic surgeon. Unrepaired caudal deviations can cause twisting of the lower third of the nose.
Crooked or absent cartilage at the caudal end wil also lead to loss of a major tip support mechanism. This can lead to underpro-jection of the nose and tip ptosis. Finally, the deviated nasal septum can result in colu-mellar irregularities.
Amendment of the nasal septum
Septoplsty is holding this process when it is deformed nasal septum and performer to difficulty breathing, headaches and can hold rhinoplasty together.
Saddle nose Surgery
A common treatment for saddle nose is rhinoplasty reconstitution. The indication depends on several factors such as the cause of the problem, the degree of lowering of the nose bridge, among others.
There are seven main ways to treat saddle nose deformity:
- Septal manipulation. Usually doct manipulate the septal structures into correct alignment and to counteract continuing deformity by force by leaving nasal packing for about seven days.
- Nasal elevation. A second method is to elevate depressed nasal tab some form of suspension. This requires a head cap and a mechanical device to apply for retraction to the nose. This poor treatment you when this saddle is associated with extensive comminution of the nasal bones or a telescoping frontal injury.
- Skin grafting. Third, the superintendent saddle is small and there not very much displacement of the nasal bones, the deformity may be corrected with a cartilage graph to the area.
- Rib Grafts. Irradiated rib grafts can be obtained from blood banks and utilized to build the nasal dorsum if there is a significant defect of the nasal dorsum that is not amenable for treatment with conventional grafts from the patient’s own cartilage if the patient does not desire harvesting from his or her own rib area.
- Inferior Turbinate Surgery. At surgery, the inferior turbinate is dissected and sectioned with scissors so as to leave intact periosteum. The use of inferior turbinate is favorable for the reconstruction of the saddle nose, as it is readily available, low cost, ready for use without resorption in long term and is not necessary a secondary donor area and increasing the air passage, thereby preventing a possible obstruction.
- Rhinoplasty plastic surgery. Finally, in selected cases, the superintendent saddle due to a fractured nose and fracture dislocation of the nasal septum may be treated by an immediate rhinoplasty.
- Silicon droplet technique. The modified serial droplet technique, termed the microdroplet” technique can be used for silicone, injecting 0.01ml per droplet.18 Any more than this puts the patient at risk for a severe granulomatous reaction.9 As with HA, undercorrection is important with silicone as a fibroblastic reaction is seen in the corrected area weeks to months after treatment. Of note, this treatment method is controversial, and has been associated with small vessel thrombosis, skin necrosis, infection, and granuloma formation. Silicone in particular has been identified as putting the patient at significant risk of necrosis, and risks verses benefits should be carefully weighed before use
Materials Used in Saddle Nose Surgery
The type of material to be used for correction of the saddle nose should excel the characteristics of being easily obtained, molded, low cost, cause minimal tissue reaction and reabsorption by the body.
Although silicon is easier to model the organic we preferred grafts of cartilage, bone or even osteocartilaginous segment obtained ribs (7th, 8th and 9th). We also prefer access via intranasal, and never external to introduce the graft.
Cosmetic Secondary Rhinoplasty
Rhinoplasty, or nose reshaping surgery, is the only way to repair the functional and cosmetic damage to a nose affected by saddle nose deformity.
Secondary operations and these operations take place in order to evaluate the nose for a new phase to raise the remaining distortions in the nose and improve the external appearance.
According to Ramos et al. the correction of the saddle nose can be performed by different techniques and / or surgical tactics, but the use of the flap of the ear shows good result.
The advantage of using this flap is open to the donor area of ease of removal and aesthetic result, however, the disadvantage, there is the need to redo the surgery, because sometimes at the retail absorption of inconvenience and technical difficulties inherent to the nasal pyramid (2).
Is Saddle Nose Surgery Necessary?
The lower nasal bridge usually does not cause health problems, so the plastic surgery is not a necessity. If the person is not satisfied with the appearance of the nose, you should talk to a plastic surgeon about how plastic surgery can reshape the nasal bridge. The results of surgery depend on the degree of lowering of the nasal bridge as well as other facial features.
Saddle Nose in Children
The facial features of infants and young children are not yet fully developed. If there is no disease, the facial features of children will be developing and becoming more prominent with the growth.
When the child has low nasal bridge, but has no other symptoms or signs of health problems or genetic abnormalities, usually no cause for concern. When parents are not sure whether the child’s nose shape is normal, they should make an appointment with a pediatrician.