Workup
Imaging Studies
See the list below:
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The standard series of photographs should be obtained prior to surgical planning for rhinoplasty.
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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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Media Gallery
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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.
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Patient (former boxer) with moderate-to-severe (type 3) saddle-nose deformity.
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Patient with a history of relapsing polychondritis and severe saddle-nose deformity (type 4).
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Close-up view of auricular cartilage damage secondary to relapsing polychondritis with a saddle nose in the background.
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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.
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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.
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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.
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Conchal cartilage can be used as layered or sandwich grafts to fill defects on the nasal dorsum and to reconstruct columellar support.
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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.
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Rib cartilage can be sculpted to serve as an onlay graft to augment the nasal dorsal contour.
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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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