Abstract
Saddle nose correction remains a challenging procedure for rhinoplasty surgeons due
to both aesthetic and functional issues. The most common causes of saddle nose are
nasal trauma and prior septal surgery, and a defective relationship between the caudal
septum and the anterior septal spine is the principal postoperative pathology. The
authors propose their own classification system for saddle nose with one new category
and several approaches to deal with this condition in accordance with the level of
severity. They strongly advocate major septal reconstruction for most cases of saddle
nose, either by placing extended spreader grafts, caudal extension grafts, or a new
extracorporeally made L strut. For extreme cases, integrated dorsal implant with columellar
strut can successfully bypass the saddled nasal dorsum without dissecting the septal
mucoperichondrial pocket and achieve adequate dorsal height. Further dorsal augmentation
can be achieved by applying side/gap grafts or dorsal onlay grafts in different forms.
In cases with retracted columella, a premaxillary plumping graft is another useful
technique. Finally, in autoimmune-related saddling patients, the evidence indicates
that their aesthetic problems can be managed safely with surgery as long as the disease
is well under control.
Keywords
saddle nose - classification - augmentation rhinoplasty - nasal septal reconstruction
