What is Saddle Nose
Saddle nose is a deformity in the nose where it is related to the abnormality in the height of the nose because a collapse in the nose’s bridge. There is a poor septal support related to trauma or aggressive rhinoplasty and even sniffing out cocaine. Saddle nose is also called as pug nose or boxer’s nose. Interestingly, having a saddle nose deformity can also be associated with various problems like polychondritis, abuse of cocaine, Wegener’s granulomatosis, Leprosy and congenital syphilis.
The patient has saddle nose when there is a fracture on the bone or septal cartilage which results to the septal hematoma. During hematoma, there is a blood collection and clot which prevents providing blood supply to the cartilage. When this happens, there is a hole created in the septal cartilage. The formation of hole then weakens the nasal septum and leads to the collapse of the nasal bridge.
Experts find it difficult to determine whether it is prevalent in men or women. However, they were able to assess that this condition happens to people who are prone to having a trauma on the face. This includes the athletes, boxers and even criminals. Cocaine addicts also have high tendency of having saddle nose deformity along with those who underwent a surgery of the nose.
Causes of Saddle Nose Deformity
There are different causes why saddle nose can happen. This can be related to:
1. Rhinoplasty that is overaggressive. Having a nose lift or rhinoplasty can result to the loss of support in the nose bridge.
2. Coccaine addiction. Cocaine is a prohibited drug where the powder is sniffed by the nose. Coccaine itself can cause vasoconstriction which will lessen the space for blood supple into the nasal septum. This will then limit the blood supply into the nasal area and cause the septum to collapse.
3. Late congenital syphilis. Congenital syphilis as the term describes happens during pregnancy. This happens when the mother has syphilis during her pregnancy and then the child is born with a condition called secondary syphilis. There are 2 classifications of congenital syphilis. In the early stage the problem seems asymptomatic. This problem is only diagnosed when doing a prenatal screening but this happens rarely.
During the late stage, the different signs and symptoms start to show which includes having a saddle nose. Along with it are other manifestations like deafness, having swollen knees, a defect on the hard palate, an upper incisor which is blunted and other manifestations.
4. Wegener’s granulomatosis. This is also called as GPA or granulomatosis with polyangitis which is a condition that is an incurable vasculitis. Vasculitis means there is an inflammation on the blood vessels thus the diameter of the blood vessels become smaller. This problem affects different parts of the body like the lungs, kidneys, nose and other organs. Because the problem is incurable, this is a potentially life-threatening disease thus patients need to be taking immunosuppressions. In most cases, the survival rate of patients with this condition can reach up to 5 years. This is because of the toxicity of the treatment that can result to death.
The manifestations for GPA or granulomatosis with polyangitis include saddle nose because the septum is perforated, nosebleed, rhinitis, hearing loss, chronic renal failure and rapid glumerulonephritis, strawberry gingivitis, scleritis, conjunctivitis, pulmonary nodules and many more.
Saddle Nose Deformity Pictures
Picture 1 : Saddle nose deformity in congenital syphilis
Picture 2 : Saddle nose deformity in leprosy
Image source : atsu.edu
Complications Of Having a Saddle Nose
The nose is important because it is the organ for smelling and breathing. The oxygen comes through the nose and passes through the airways and eventually into the trachea and to the lungs. There is an exchange of oxygen and carbon dioxide and you exhale through your nose and release carbon dioxide from the body. The human nose also comprise of cartilages and bones to for the nasal structure to be formed. The osseocartilaginous is the framework that supports the nasal bones. It is connected with the lower and upper nasal cartilages, premaxilla and the septum.
If there is a saddle nose deformity, the problem is not directly life threatening but it will result to discomfort and development of airway obstruction in the long run. Experts call a middle vault collapse or a collapse in the nasal bridge can also cause airway obstruction. Additionally, the patient’s self-esteem will also be affected that’s why they want to have an aesthetic improvement on their nose as part of the treatment.
Saddle Nose Deformity Treatment
To confirm that the patient has a saddle nose, imaging studies are needed. Then the depth of the problem will determine the treatment options such as surgery.
The option for a medical treatment is raised and applied only when the goal of the treatment is to stop or prevent the disease progression like in cases of Wegener granulomatosis. Consulting to a rheumatologist is essential because they know the treatment process and how to avoid further damage to the nasal cartilage.
This is the best option to correct the saddle nose. Nasal reconstruction involves using of implants to raise the nasal bridge. There are different options for the implant to be used in repairing the nose which includes:
- Homografts that uses accelular dermis
- Autografts which makes use of the rib or the patient’s finger or the cartilage of the auricle
- Metals are also used like alloys, titanium, silver and gold
- Bioimplatns like coral or ivory
- Silicone, polyamide mesh and other synthetic compounds
The selection of the implants should is critical because it should stay in the body for a long time thus biocompatibility is important along with the availability of the material, the morbidity on the graft’s harvest area, and other. The following criteria should include:
- It should be noncarinogenic
- It should not be absorbable
- It should have extrusion rate of zero or very low
- Cost effective
- Should feel like a cartilage
- The material should be easy to work with
- There should be no inflammatory reaction once the implants are inserted in the nasal area
If the implant passes all these criteria then it will last about 10 years in the body. A careful evaluation and reassessment should be done after the operation to ensure that the implant is in place and at the same time avoid infection.