Saddle Nose Deformity: Causes and Treatment Options

Saddle nose deformity—also known as “pug nose” or “boxer’s nose”—is the name for a collapse of the central third of the nose bridge, which creates a dip or “saddle” in the nose’s appearance.  It is generally the result of a loss of structure in the septum, the area of cartilage in the center of your nose that divides your nostrils. In mild cases, a saddle nose’s effects are simply aesthetic—just a change in shape. In more severe cases, the saddle nose deformity can obstruct the nasal airways, causing difficulty in breathing.

The most common cause of the saddle nose deformity is trauma. In fact, saddle nose is also called “boxer’s nose” because the deformity can be easily caused by a punch to the face or similar impact. Injuries from sports like hockey and football are frequent sources for the saddle nose deformity, and trauma from automobile accidents can also be a cause.  In rarer cases, saddle nose can be caused by diseases such as Wegener’s granulomatosis or congenital syphilis. Finally, improper treatment of septum cartilage during cosmetic rhinoplasty can also be a cause—an important reason to choose your plastic surgeon carefully if elective rhinoplasty is in your future.

Whatever the cause, the saddle nose deformity can be corrected with reconstructive plastic surgery (though if the deformity is caused by complications of a disease it is necessary for the disease to be properly under control prior to surgical correction). The type of surgery needed depends in part on the severity of the saddle nose deformity, and whether other complicating conditions are present.

For mild cases, in which breathing is not affected, a simple onlay graft of cartilage or solid silicone can correct the shape of the nose. Many surgeons prefer to use the patient’s own cartilage if at all possible, and this cartilage can be taken from the ears, the ribs, or elsewhere in the nose. The cartilage is then grafted to the bridge of the nose in the appropriate location to rebuild the saddle. This type of reconstruction is the most straightforward, because it corrects only the shape of the nose, rather than its underlying structure.

For more moderate to severe cases of saddle nose, in which the nasal valves are compromised, a slightly different technique needs to be used. The upper lateral cartilages, which support the sides of the nose, are separated from the bridge. A spreader graft is then put in place to separate the lateral cartilages.  This opens up the airways to ease breathing, as well as elevating bridge of the nose to decrease the saddle.

The lower lateral cartilage and the tip of the nose may also be involved in difficulties breathing, and if the deformity is truly severe the entire septum may need to be reconstructed. In these cases, in the place of the spreader graft, an L-shaped structure will be used to provide support to the bridge and re-create the septum. An additional small graft may be needed to shape the lower lateral cartilages and tip.

For the most detailed and accurate information about your nose and its specific needs, it’s best to consult a qualified 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.

Jamie Northrop

Jamie Northrup is a medical writer from California.

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