Saddlenose

Saddlenose, or saddle nose deformity, is a nasal condition in which the bridge of the nose (the nasal dorsum) collapses or becomes sunken, creating a concave, saddle-like profile. The deformity may involve loss or weakening of septal cartilage and surrounding support structures, and can be accompanied by nasal obstruction, crusting, or nasal valve insufficiency. It can be purely cosmetic or associated with functional impairment.

Causes are diverse and include traumatic injury that damages nasal septal cartilage or bones, chronic inflammation, or disease processes that destroy nasal support. Common medical causes are granulomatosis with polyangiitis (formerly Wegener’s granulomatosis), other vasculitides, and chronic infections such as syphilis or leprosy. Cocaine or other vasoconstrictive drug use can produce septal perforation and subsequent saddle deformity. Iatrogenic factors include complications after rhinoplasty or nasal surgeries that compromise the dorsal support. Less frequently, congenital conditions or severe congenital nasal abnormalities can present with saddle nose.

Diagnosis involves clinical examination and patient history to identify underlying etiologies. Endoscopic assessment and imaging (such as CT) help delineate the extent of dorsal collapse and damage to cartilage and bone. Laboratory tests may be indicated to evaluate for systemic diseases (for example, serologic tests for vasculitis or syphilis).

Treatment focuses on addressing the underlying cause and restoring nasal structure. Management of the disease process is essential when applicable. Reconstructive surgery is commonly pursued to rebuild the dorsum using autologous grafts (such as cartilage from the septum, ear, or rib, or bone grafts) and soft tissue support. In some cases, a staged approach or graft combinations are used. Prognosis depends on etiology and the durability of reconstruction; chronic inflammatory disease may require ongoing management to prevent recurrence.