Saddle Nose – Causes, Treatment, and Cure

imagesSaddle 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

Infiltration_of_skin_due_to_endemic_syphilis

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.

images (12)Treatment: Infants with congenital syphilis are treated with antibiotics to kill the infection. However, the treatment has limited success rate.

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.

Dysostosis cleidocranial

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.

images (12)Treatment: Control of the dorsal septum often requires separation of the upper lateral cartilages and placement of spreader grafts to open and maintain a satisfactory valve angle.

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.

images (12)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.

Wegener’s Granulomatosis and Saddle Nose

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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.

images (12)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.

images (12)Treatment: Rhinoplasty. In most cases, this operation is performed in order to minimize the nose and show better, especially when the nose Kparaoaather heavily on psychological aspects.

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)

Fetal

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.

images (12)Treatment: The nasal profile is best elevated by cancellous bone graft. Although it is possible to re-condition the middle thisd of the face by the use of dental plumpers.

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.

images (12)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.

images (12)Treatment: Method of multiple treatment or fill an integral part of the support tissue graft is an artificial method of planting project.

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

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.

images (12)Treatment: Correction of the underdevelopsd maxilla lies in arrest of the causal factors and in surgical repair of the deformities.

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:

  • GP
  • Pediatrician
  • Geneticist
  • 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

Saddel_nose2

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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

1024px-Opening_space_above_septum_and_between_nostrils_during_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.

Flap Surgery

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.

 

What Is Saddle Nose?

41272tnSaddle nose deformity has been known since time immemorial, and different repair procedures have been trying from time to time. Corrective surgery dictated when saddle nose causes nasal obstruction or the person wants a static improvement of his nose.

Saddle nose definition: The term saddle nose deformity was coined to describe nasal profile resembling a riding saddle.

Usually it is characterized by presenting:

  • Nasal pyramid depression
  • Loss of definition and support nose
  • Nasal length shortened
  • Retrusion of the nasal septum and caudal spine.

The saddle nose is defined as abnormally concave dorsum of the nose with an apparent projection of the nasal tip. Either bony or cartilaginous, or bold portions may be affected.

Saddle nose for many may be relative or true. Relative is when there is a hump formation or excessive projection of the nasal tip or both. In true saddle deformity, there is actual loss tissues along the dorsal nasal line.

What is saddle nose?

Saddle nose (saddle nose) refers to the dorsum bone and cartilage inward showing varying degrees of depression, upturned nose, the nose forward, shaped like a saddle named, it is one of the most common nasal deformities.

Saddle nose caused by how? What’s the matter?

Saddle nose nasal stents composed mainly of nasal septum and damage caused, or as well as the inner wall of the nasal mucosa causes nasal trauma, nasal septum bending inappropriate corrective surgery or from syphilis, leprosy and other specific infections, or severe suppurative infection, can also be due to congenital nasal, septal cartilage dysplasia due.

Saddle nose early symptoms? What performance?

Simple saddle nose: nose flat or showed only mild depression, may be associated with blunt flat nose, nasal no more physiological dysfunction.
Complexity saddle nose: more nasal tissue removal or infections caused by trauma, manifested as bone and cartilage of the nose portion obvious retraction, shaped like a saddle, nose axis shortening, upturned nose, back, forward and upward anterior nasal aperture appears dish face deformity (dish face).

Saddle nose deformity looks much only loss, but with severe septal thickening bending deformation, or the inner wall of severe scar contracture can also hinder nasal breathing and pronunciation.
Difficulty breathing infection skeletal abnormalities nose low (low nose)

Saddle nose how to diagnose? How?

Diagnostic tests:

x-ray examination to determine the extent and scope of the saddle nose, diagnosis and treatment.
Differential diagnosis:
Saddle nose into their reasons for congenital and acquired saddle nose, congenital domestic to saddle nose common; according to the degree of deformity divided into simple and complex saddle nose.

Treatment of Saddle Nose

The first is traditional until today still think it is a more reliable method, which uses its own tissue (bone or cartilage) were implanted filling nose bridge of the nose section. This surgical method involves two bodies.

First place in the body of a cut piece of bone or cartilage (such as ribs, iliac, etc.), then press the nose carved type required to make the necessary engraving, the satisfaction, or in the nostrils and nasal columella incision along the design along the tip of the nose, the nose of the subcutaneous tissue sneak separation, resulting in a tunnel.

After proper hemostasis, the carving good bone or cartilage tissue implanted in the subcutaneous tunnel, the finished shape, look and feel can be satisfied after the incision was sutured, and then implanted with stamp glue bone or cartilage, six days stitches you can get satisfactory results.
Advantage of this autologous tissue transplantation is less prone to rejection or allergic reactions, surgical success rate. But because two incisions to do the surgery, and six months after the bone tissue easily deform and absorb, and therefore is not the most perfect way.

 

Saddle Nose Caused by Syphilis – What’s the Connection?

1024px-Fibrous_papule_of_the_nose_01Low nasal bridge, sometimes it is caused by infectious or genetic diseases. The general underlying cause is determined and treated soon after birth.

The characteristics of a child, of course, are less developed at birth and in time, the nose bridge can acquire a more normal appearance.

The Saddle Nose Surgical Center of Western Illinois states: “One of the most shocking symptoms of advanced syphilis is the gaping hole left in the center of the face where the disease had eaten away the flesh and cartilage of the nose. Early and proper treatment of infections such as Syphilis, Leprosy or Tuberculosis reduces possible damage to the nose.”

Syphilis in Infants and Babies

If syphilis is not treated in newborn babies, it exhibits itself in adults with signs of:

  • deafness,
  • blunted teeth, (incisors),
  • swollen knees
  • and saddle nose syphilis.

Almost 50 percent of infants with congenital syphilis are stillborn or die shortly after birth, according to the National Institutes of Health ( NIH , 2012 ).

If the doctor suspects that the child’s nose shape is caused by an underlying problem, you can order tests to detect genetic abnormalities or other health problems.

Tests may include:

  • X-rays to see the child’s nose structure
  • chromosomes tests for detecting genetic abnormalities
  • blood tests to detect infection and check the levels of enzymes

The fact that a person or a child have low nasal bridge (also called saddle nose) without prejudice to the breath. You can reshape the nasal bridge with plastic surgery, if the person bothering to look.

Causes of Saddle Nose

The underlying causes of low nasal bridge are present at birth. They are usually diagnosed at birth or soon after it. The causes include genetic disorders, birth defects, and infectious diseases.

Congenital syphilis is a severe and potentially life-threatening infection in infants. Babies born with congenital syphilis frequently have no bridge to nose (saddle nose) and severe congenital pneumonia.

Treatment of Saddle Nose

Building or nose Nasal Reconstruction manufacturing in pathological cases or cancer that the patient loses his nose. Or get deformed in the bones and cartilage that needs to add the bones and cartilage to highlight the shape of the external nose.

Are taking these bones and cartilage from the same person either from the pelvic bones or ribs or ear flap and skin to cover the bones from nearby or remote bodies as the extremities or the abdominal tissue.

And can be used for industrial materials such as (silicone instead of bone or cartilage or put artificial nose in the case of the impossibility of conducting operations for many reasons.

From a developmental point of view of the nose, saddle nose cosmetic surgery is best performed after puberty is more appropriate that after 17 years were, because when the nasal bone and soft bone hair infertility has been basically finalized, it will not be too much after changes. Medical Aesthetic Plastic surgery is called to elevate Biliang rhinoplasty.

Saddle Nose Causes

indexSaddle nose is a nasal deformation in the bridge of the nose (the upper part) is flattened, often very close to the rest of the face.

Causes of Saddle Nose

The saddle nose can be congenital. In such cases, it is linked to genetic syndromes or fetal deformities, such as:

  • Williams Syndrome
  • Down’s syndrome
  • Dysostosis cleidocranial
  • Fetal alcohol syndrome
  • Syphilis congenital.
  • In addition, the saddle nose can be purchased at some trauma, and is common in athletes, boxers and others who are exposed to shocks in the region.
  • Patients who may suffer the same trauma repeatedly due to their profession, such as boxers
  • Patients as chronic or autoimmune diseases, which may again have this condition later
  • People who demonstrate risk in general for rhinoplasty, as people who use intranasal drugs (such as cocaine), have chronic conditions that make risky surgery, patients with unrealistic expectations, among other …

The problem may also be related to diseases such as leprosy (also known as leprosy), relapsing polychondritis and Wegener’s granulomatosis.

Often, however, the person may have the lower nasal bridge and it resemble the saddle nose. This is common for members of some ethnic groups.

Other Causes of Saddle Nose

Infections of the nasal septum, leishmaniasis, leprosy, surgeries performed improperly (septpoplastias and rinoplatias) and bruises in the boxer’s nose are the most frequent causes of previous depression of the nasal dorsum.

Syphilis, leprosy and craniofacial trauma (injuries, traffic accidents etc.) are responsible for the sinking of the posterior segment. The nasomaxillary hypoplasia is also a special form of saddle nose.

Broken Nose Trauma

A broken nose is perhaps one of the most common injuries known to man. It is important to treat nasal fractures promptly and adequately to prevent saddle nose deformity.

Nasal injuries are more common in athletes and children, where they are usually undetected and untreated. Complications include septal hematoma or septal Alsace, which can lead to saddle nose deformity.

Rhinoplasty and Saddle Nose

Excess removal of the nasal structure during rhinoplasty has also been found to cause saddle nose. In such situations, either parts of the structure of the septal cartilage is reposed to avoid post rhinoplasty saddle deformity.

Nasal septum in the support and Armature of the nose. External changes occurring after two extensive removal of septal support may lead to:

  • Saddle nose deformity of the cartilaginous dorsum
  • retraction of the column
  • drooping of the nasal tip
  • widening of the nasal vestibule
  • decrease in the nasolabial angle

Depression of the cartilaginous portion is particularly seen when dorsal segment of the septal cartilage is removed during submucous resection and nasal flaps are injured and torn.

Some of these deformities appear early, while others occur after a lapse of a few months or even a year. Scar tissue takes about a year to mature.
Saddle Nose diagnostic
To find out if the saddle nose is related to some underlying disease, the doctor first talk to the patient and their parents, in the case of a child, to understand that other symptoms can lead their diagnosis. A physical examination should also be done.

In addition, according to his suspicions about the possible causes of the saddle nose, you can ask for other tests. Between them:

  • Genetic tests, if he suspected a genetic source of the problem
  • X-ray of the skull, to understand the structure of the nose
  • Blood tests, to check for infection or other problems.
    diagnosis and examinations

Seeking medical help
How often the saddle nose may be commonplace, seek medical help if your child shows other unusual characteristics in the face. However, as most of the problems is congenital, it probably will be also realized by the pediatrician at birth or in clinical practice.

Causes of saddle nose deformity include resection of the nasal septum, trauma, infection, genetic inheritance, and developmental factors from birth.

Treatment

The nose of the saddle treatment is surgical and consists of adding cartilage, bone or aloplásticas substances over his very bones, aiming to raise the nasal dorsum.

Saddle Nose Treatment

BHCPatient3Because the present methods of treatment either variable results or are given only for specific indications, I have treated a patient by different method.

In this case, correction and on the superintendent deformity was achieved by inserting a process heterogeneous bone transplant between the nasal mucous membrane lapse and maintain it in correct position by suture inserted through holes drilled in the bone.

In this way, or support to the tip of the nose was achieved by means of a strut place inside the nasal septum.

 

Saddle nose treatment? How to prevent?
Treatment Summary saddle nose:
Saddle nose can be filled by suitable materials rhinoplasty to achieve booster Biliang, raise the nose purposes. Simple saddle nose multi-use medical silicone rubber. The complexity of the saddle nose surgery nose transection extended method, skin, mucous membranes release prolong graft law, forehead flap correct severe saddle nose, smelly nose surgery psychosis.
Saddle nose detailed treatment:
Treatment:
Currently, the treatment of saddle nose filling materials often used in autologous bone, autologous cartilage, medical silicone rubber and ePTFE (expanded polytetrafluoroethylene, e-PTFE) and the like.

Simple saddle nose multi-use medical silicone rubber. But with flat or rounded nose saddle nose patient complexity, the choice of “L” shaped silicone rubber filled the nose could easily lead to nasal tip skin tension is too large, skin perforation, ulceration and other complications, should be careful. It suggested the use of autologous cartilage or autogenous bone graft.
It should be noted that normal nose also has high, medium and low points, the latter from the bridge of the nose to the tip of the nose performance were significantly low and flat, due to congenital dysplasia.

In addition to national requirements by saddle nose rhinoplasty, there are a considerable part of the low bridge and the bridge of the nose who still hopes to rhinoplasty to improve appearance, increase the dimension of the nose. Saddle nose with a low bridge who are absolute indications rhinoplasty, while the person is a relative indication nose rhinoplasty.
(A) simple saddle nose surgery
1. Indications
Suitable for simple mild to moderate saddle nose, no obvious who deviated septum.
2. Operating Highlights
(1) prosthesis positioning: draw the eyebrows to the longitudinal axis of the nose, two inner canthal brow and the midpoint of the horizontal line, two lines intersect at the upper edge of the nose prosthesis, the width of the prosthesis should be based on the patient’s nose depending on the width and face length.
(2) prosthesis selection: commonly used filling materials are medical silicone, autologous bone and cartilage, e-PTFE and so on.
(3) prosthesis preparation: depending on design requirements sculpture prosthesis. After sterilized.
(4) anesthesia: in the nose, nasal dorsum small columns and fascia injection of local anesthetic.
(5) cut: generally used nostril incision, delphinium incision like. Intranasal incision: hidden incision, no scar, less blood loss. Nasal incision: easy surgical procedures, can raise the nose skin, long-term scar is not obvious. Incision and conducive to covert operations better.
(6) separation: separation with elongated scissors to sneak through the incision along the lower end of the nasal dorsum cartilage surface, and then, with periosteal stripping the nasal bone periosteum separated form the corresponding implant cavities, in order to ensure the prosthesis is located in the dorsum of the fascia deep.

Separation range of the bridge of the nose section, down to the tip of the nose, on both sides of the prosthesis according to the width may be, should be slightly larger than the width of the prosthesis, after the soft tissue to the implant without too much tension for the degree. If it is “L” shaped implants, you need to separate the rear of the alar cartilage inside of the foot until the anterior nasal spine.
(7) The implantation of the prosthesis: After hemostasis, the sculpture good nose prosthesis into the compartment. After confirmation, the incision was sutured.
(Ii) the complexity of the saddle nose surgery
1. The extension of the nasal cross-sectional method
(1) Indications: saddle nose deformity was complete lower nasal structure.
(2) operating points
1) lower nasal reset: in the nose and the top of the nose to make curved incision nose full thickness to form an interlinked pierced nasal defect, the lower end of the nose down reset, extended nose axis.
2) repair ripped defects: bridge of the nose portion in an appropriately sized Flip subcutaneous pedicle flap, surrounded by suturing the wound edge and the nasal mucosa, the nasal lining repair defects, then to a sliding board vessels axis of rotation forehead island flap covering the nose wound, for valve area or take direct suture full thickness skin graft coverage. Or nasolabial fold at both sides of the appropriate size for each set off a flap or island flap, lined with a flip, rotate another flap repair nasal skin defects, two watt together. Nasolabial area on both sides of the wound for direct suture.
2. skin, mucous membrane graft law extended release
(1) Indications: Severe saddle nose deformity, skin and mucous membranes were intact.
(2) operating points
1) extend the nasal skin: on the nose edge and columellar do “U” shaped incision, close to the surface of the cartilage and periosteum makes extensive skin peeling, from the eyebrows on both sides to the maxillary, zygomatic, down to the upper lip , making the skin loose, move to pull the nose.
2) extension of the nasal lining: retractor incision to expose the nasal bone and cartilage, at the edge of the curved incision about 1.5cm pear-shaped hole in the periosteum, stripped down and set off periosteal flap, to the pear-shaped hole edge. The nasal bone periosteum and nasal mucosa apart and transverse incision of the septal mucosa, pear-shaped hole upper part of the nasal cavity connected. Continue along the piriform stripped down both sides of the hole, so that together with the lower part of the nose together periosteal flap downward shift, the periosteal flap covering the ripped defect, which hit the upper edge of the pear-shaped hole edge suture.
3) correction of saddle deformity: cut from the iliac bone or cartilage, carved into the “L” shaped bracket, placing the nose position, its deep surface fit closely with the nasal bone, nasal columella base arrived at the anterior nasal spine.
4) Singles plane deformity correction: in the gingival sulcus incision in the periosteum peeled pear shaped up along the sides of the hole, a gap is formed under the periosteum, the bone will be cut and pear-shaped hole Xiu consistent arc shape, planted in the piriform both sides of the hole and on the alveolar concave, with wire fixation. Close gingival sulcus incision.
3. Correction of forehead flap saddle nose, ozena
(1) Indications: Severe saddle nose, ozena patients, nasal skin intact.
(2) operating points
1) from the inner edge of the nostril nasal cartilage incision on both sides through to the dorsum and nasal tip with scissors to make widely separated, the full release contracture, the adhesion, the shift of tissue repositioning, extended nose.
2) Press the wounds left after prolonged nose size, cut on one or both sides to tackle vascular pedicled forehead island flap between the forehead, nose hit a tunnel, which will be introduced by the flap intranasal, turn inward, and the inner edge of the nasal mucosa corresponds to suture wounds. In the nasal septum at the intermediate skin flap may be cut off to the sides, and septal mucosa suture. Valve area for a little separation can be directly sutured.
Saddle nose ate? Dietary health?
Saddle nose daily care? Precautions?
Simple saddle nose surgery postoperative care: 24 ~ 48h after dressing, after 6 ~ 7d stitches.
Simple saddle nose surgery complications:
(1) infection and hematoma.
(2) rejection or prosthetic nose down cause skin ulceration exposed.
(3) nasal prosthesis deflection, loose ends Alice move.
(4) prosthetic nose reveals translucent shadow

 

Saddle nose is a nose deformity, nose intermediate depression, caused by nasal trauma, syphilis, tuberculosis

As rhinoplasty beauty who, the vast majority of mild and moderate saddle nose.
Saddle nose – rhinoplasty common method
Claim Organization: doctor net saddle nose topic
Foreign tissue or artificial tissue implant
The second method is to use allograft tissue implants or the use of synthetic polymer compound instead of autologous bone or cartilage tissue implant of rhinoplasty. Its material is allogeneic bone tissue, such as cutting down on childhood bid cartilage organizations. The most commonly used at home and abroad is a solid silicone rubber such polymer materials. Using these allogeneic bone or substitutes do long high nose surgery, can greatly reduce the suffering of beauty and materials readily available and inexpensive, convenient and beautiful shaping, most people do not appear rejection, and therefore welcomed by the masses. However, it is worth noting that very few people will appear after allogeneic tissue implants or silicone rubber swelling reaction even wound healing, leading to rejection, which requires surgical removal of the implant again. So for some people with allergies do rhinoplasty cosmetic surgery need to take seriously, do not easily surgery, so as not to cause pain.
Injection rhinoplasty
The third method is injection rhinoplasty. Now many places are to carry out such operations. The material is typically injected liquid silicone rubber. This method is simple, less pain, shaping also more aesthetic advantages. Coupled without surgery can achieve the purpose of beauty, so welcomed by the people. Everything has its duality, this method is all the rage after the country, there have been many problems. As will cause incomplete solidification after injection of silicone rubber, causing spherical distortion make the nose but not the United States or, worse still cause skin allergies, skin erosion, perforation, so its application is limited. Especially in the long nose, since nose less subcutaneous tissue, the skin is relatively weak, and cause a skin ulceration, scar formation, the results fall beauty without even a scar. Cause lifelong suffering. Then the liquid silicone rubber is not impossible to use it? No. Rich parts of the subcutaneous tissue, such as the jaw, forehead, etc., or a small amount of liquid injectable silicone rubber, can play to improve the imbalance in the face of the goal. But for rhinoplasty or not liquid silicone rubber as well.
Indications
Nose flat or depressed; the complexity of the merger of the external skin, nose, within the nasal mucosa, nasal defect or scar contracture, septal defect; noma were merged columella, upper lip defect.
other issues
1. Simple saddle nose showed only flat or sunken nose, nose or nose showed support still blunt and flat, nasal no more physiological dysfunction. In this regard, the aforementioned cosmetic rhinoplasty to get a good shape.
2. Complex obvious saddle nose bridge of the nose to collapse, shorten the length of the nose, upturned nose, the nose forward, nasolabial angle greater than 110 °, depressed nasal base, accompanied by cartilage, mucous membrane or skin contracture, nose and nasolabial fold deepens, often with midface l / 3 stunted and showed “butterfly face” deformity, nasal septum, nasal dysfunction. For this type of saddle nose, cosmetic rhinoplasty can not, must row saddle nose plasty, in order to receive better treatment.
3. surgical patients 18 years of age are developmental stages, facial or body without infection, nasal sebaceous little or no rosacea, no allergies, mental status need to be stabilized.
4. stitches after 5-7 days.
5. postoperative diet, avoid spicy food, such as: ginger, raw onions, raw garlic, chili, seafood and so on.
6. Each rhinoplasty postoperative swelling varying degrees, especially in the most obvious bridge of the nose section, usually 2-3 days swelling, without special treatment.
7. Patients should be 3-4 days of oral anti-inflammatory drugs, such as: amoxicillin.
8. can not do cosmetic surgery within a month.
9. The results of operations are not satisfied, it can be implanted prosthesis removed.
Saddle nose – saddle nose clinical manifestations
Claim Organization: doctor net saddle nose topic
1. nose flat or depressed; 2. the merger of the complexity of the external skin, nose, within the nasal mucosa, nasal defect or scar contracture, septal defect;
3. noma were merged columella, upper lip defect.
Saddle nose – saddle nose diagnosis is based
Claim Organization: doctor net saddle nose topic
1. Simple saddle nose Congenital born with deposit;
2. acquired trauma, infection and nasal septum surgeries;
3. nose flat or depressed;
4. nasal skin, mucous membranes, nasal septal defect or scar contracture, can also be combined columella, upper lip defect.
Saddle nose – saddle nose treatment principles
Claim Organization: doctor net saddle nose topic
1. Simple saddle nose: rhinoplasty performed. Transplanted tissue as cartilage, rib or medical silicone rubber and other tissue substitutes, autologous cartilage or rib as well.
2. The complexity of the saddle nose: scar excision and skin grafting or flap release method; graft prosthesis support inline method.
Saddle nose – saddle nose medication principle
Claim Organization: doctor net saddle nose topic
1. Under normal circumstances surgery, medication to medication box to limit the “A”, “B” main.
2. When economic conditions permit or postoperative infection “A” key drugs ineffective, medication may include medication box to limit the “A”, “B”, “C”.
Saddle nose – auxiliary examination
Claim Organization: doctor net saddle nose topic
1. Under normal circumstances, the check box to limit the project to check the “A” main;
2. complex even when deformity or surgical complications, check the project may include a check box to limit the “A”, “B”.
Saddle nose – saddle nose Evaluation
Claim Organization: doctor net saddle nose topic
1. Cure: Recovery nose straight, nose has not downward projection, nasal labial angle slightly greater than 90 °
2. Improvement: Bridge recover relatively straight, nose lips approaching 90 °.
3. Healed: low-lying bridge of the nose is not restored.
Saddle nose – repair surgery
Claim Organization: doctor net saddle nose topic
1. cut: past use of intranasal incision, skin incision on one side of the septum between the nasal columella, thus re-enter the dorsum subcutaneous tissue.

However, in addition to at least one intranasal incision in the external nasal surgery scar, there are few other advantages, when it can not be applied to raise the nose. The incision scar is actually the bottom of the nose is not significant, in disinfection or are more advantageous in terms of the surgical procedure, especially for installation of “L” shaped model is more ideal. Common nasal incision in two ways: one is from the nose down along columella incision has been made; the other is self columellar nostril along the leading edge of the front end to make a “T” shaped incision, the actual operation may need adoption.
2. Use a small pair of scissors from the incision extends into the nose peel back side edge scissors, separation of adhesions between the subcutaneous tissue and nasal dorsum, from the eyebrows to the outside on the outside of the nasal dorsum maxilla, nasal bone and subcutaneous tissue must between complete relaxation.
3. The Department of spindle model, can be placed to observe the shape of the nose to rectify the situation, first of all should pay attention to the base with the case of the saddle nose bone model of the recess is appropriate, according to the model is the tip of the nose bridge of the nose end whether it will tilt, such as basal inappropriate, model prone to cause distortions caused deformities, such as too large or substrate irregularities and can be modified; too are more interchangeable into a larger model.
4. use “L” shaped model, should the central pillar in the small compartment separate until the bottom of the columella, down through the maxillary nasal spine; as xenograft model for their own cartilage, septum mucous membranes should be separate, and then placed in the model ; in the case of soft plastic model after model can be folded into a small pillar columellar it can fold up into the nasal after release, pay attention to the model put it, although there are in the columella strut, When pressing the tip of the nose bridge of the nose model of the terminal will not be lifted, but tension should not be too large, otherwise may hinder dorsum skin blood supply, causing necrosis induced model piercing, especially plastic models causing more surgical failure, therefore, as the tension is too large The model can be removed, repair of small to absolutely no tension but far more suitable.
5. The nose shape correction has been satisfied, can be cut with a silk suture skin, nasal dorsum cover a little gauze, with dorsum bracket (available dental proofing glue or aluminum sheet) and tape, fixed nose shape is not deformed .
Saddle nose – saddle nose after repair considerations
Claim Organization: doctor net saddle nose topic
1, the initial surgery for local cold with ice, reduce postoperative swelling, the first five days after surgery, should be local heat, promote recovery.
2, rest: time to hospitalization, pay attention to rest at home after surgery.
3, within a week after the prosthesis has not been wrapped fiber membrane in an unstable phase, so be careful not to touch, squeeze, impact local.
4, after such long-term discomfort, should go to the hospital and doctor.

 

The alloplastic implants are being used in rinocirurgias, having the advantage of simplifying the surgery, however, still a significant bounce rate.

Homografts have advantage over autografts because it is less subject to shortening. Among the used autografts there are the septal cartilage and rib. The use of a particular type of graft and a surgical technique is linked implicitly the surgeon’s experience (7).

In the historic course, considering the bone reconstruction in the face, first performed surgical procedure aimed to repair a defect head and canine xenograft was used.

For surgical correction of the saddle nose, initially, we used tibial crest, iliac, ribs, ulna and skullcap. Regarding the use of autograft rib cartilage both its segment, bone or osteocartilaginous can be handled.