Saddle Nose Rhinoplasty Workup

  • Author: A John Vartanian, MD, MS; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Jun 30, 2010
 

Imaging Studies

  • The standard series of photographs should be obtained prior to surgical planning for rhinoplasty.
  • Radiologic work-up is not necessary, unless required for medicolegal or insurance documentation.
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Diagnostic Procedures

Endoscopic nasal examination can facilitate an accurate survey of the endonasal structures.

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Contributor Information and Disclosures
Author

A John Vartanian, MD, MS  Assistant Clinical Professor, Department of Surgery, Division of Head and Neck, University of California, Los Angeles, David Geffen School of Medicine; Instructor, Department of Otolaryngology-Head and Neck Surgery, University of Southern California Keck School of Medicine

A John Vartanian, MD, MS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

J Regan Thomas, MD  Head Professor, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago Medical Center

J Regan Thomas, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

S Valentine Fernandes, MBBS, MCPS, FRCSEd, FRACS, FACS, LLB  Conjoint Senior Clinical Lecturer, Department of Otorhinolaryngology, Newcastle University; Senior Consultant Surgeon, Department of Otorhinolaryngology-Head and Neck Surgery, John Hunter, Warners Bay Private Hospitals, Australia

S Valentine Fernandes, MBBS, MCPS, FRCSEd, FRACS, FACS, LLB is a member of the following medical societies: American College of Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

David W Stepnick, MD  Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center

David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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Findings typical of a moderate-to-severe saddle nose include nasal dorsal concavity, shortened vertical nasal length, and loss of nasal tip support and projection.
Patient (former boxer) with moderate-to-severe (type 3) saddle-nose deformity.
Patient with a history of relapsing polychondritis and severe saddle-nose deformity (type 4).
Close-up view of auricular cartilage damage secondary to relapsing polychondritis with a saddle nose in the background.
Saddle-nose classification based on anatomic deficits. (1) Normal nose, appropriate nasal dorsal height, tip projection, and vertical nasal height. (2) Type 1 saddle-nose deformity, minor supratip or nasal dorsal depression, with normal projection of lower third of the nose. (3) Type 2 saddle-nose deformity, depressed nasal dorsum (moderate to severe) with relatively prominent lower third. (4) Type 3 saddle-nose deformity, depressed nasal dorsum (moderate to severe) with loss of tip support and structural deficits of the lower third of the nose. (5) Type 4 saddle-nose deformity, catastrophic (severe) nasal dorsal loss with significant loss of the nasal structures in the lower and upper thirds of the nose.
Nasal anatomy. The shape and function of the middle and lower thirds of the nose depend on the integrity of the nasal septum and on the quality and shape of the upper and lower lateral cartilages.
Lateral view of the nasal septum. The primary support for nasal dorsal height and tip projection is determined by the size and integrity of the nasal septum.
Conchal cartilage can be used as layered or sandwich grafts to fill defects on the nasal dorsum and to reconstruct columellar support.
Spreader grafts are rectangular sculpted pieces of cartilage placed between the upper lateral cartilages and septum. They serve to widen the internal nasal valve, widen the middle vault, and prevent collapse of flail upper lateral cartilages. Also, they can provide additional support to the dorsum.
Rib cartilage can be sculpted to serve as an onlay graft to augment the nasal dorsal contour.
A columellar strut can be assembled with a boat-shaped dorsal graft to reconstruct dorsal-columellar L-shaped strut. Rib cartilage can be used to carve both components of the graft.
 
 
 
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