Saddle Nose

Saddle nose is a nasal deformity marked by abnormal height/length of nose and weakened support for nose caused by collapse of the nasal bridge. The nose has a projected tip, concave dorsum, and is kind of saddled in the mid-section; hence the name. A saddle nose typically looks like a pug nose.

The bold, cartilaginous, or bony sections of the nose are usually affected in persons with saddle nose. A few characteristic features include depression of nasal pyramid; caudal spine and nasal septum retrusion; shortened length of nose; and loss of nasal support and definition.

Saddle nose may be true or relative. In the latter, there is elevated protrusion of nasal tip or occurrence of a hump, or both. In the former, there is real tissue damage or loss along the dorsal line of the nose.

Treatment of saddle nose is dependent on the underlying causative factors/condition.

Types of saddle nose

Depending on the severity of the deformity, saddle nose is classified into the below listed 3 forms:

• Mild: It is marked by minor collapse of nose which results in widened and somewhat flat nasal dorsum, micro-pits, or abnormal radians. The dorsum of nose is the nasal bridge.
• Moderate: It is marked by easily noticeable nasal collapse. Abnormalities may include extra wide nasal bridge, shorter than normal nose length, excessive projection of nasal tip, or short or flat tip of nose. Also, upturned nose may be present.
• Severe: It is marked by extreme depression of nasal dorsum and may occur along with easily visible deformity of the structure of nose and septum.

Symptoms of saddle nose

In addition to the above discussed physical deformities of the nose, a nasal septum may cause signs and symptoms such as:

• Nasal blockages
• Breathing difficulties
• Respiratory infections, which are often recurrent in nature

Causes of saddle nose

Saddle nose may be caused due to a variety of factors, the most common of which are listed below:

• The condition may be congenital, i.e., the baby may be born with the nasal deformity. The nasal abnormality may develop due to exposure of pregnant women to environmental factors during the initial pregnancy period or at the time of delivery.
• Hereditary or genetic factors can result in a big, small, mushroom-shaped, or no nose in the child. The genetic defects may be passed to the child from either one of the parents, or both. The physical defects associated with the abnormal genes can be corrected, but the genetic abnormality cannot be cured. A few examples of genetic conditions that occur with a saddle nose include,
  • Williams Syndrome, a developmental disorder, may cause a lower than normal nasal bridge.
  • Cleidocranial dysostosis may cause abnormal growth of skull and collarbone. Sometimes, affected people may feature an abnormally low bridge of nose.
  • Down syndrome is a well-known genetic disease. Patients often tend to have a saddle nose with depressed nasal bridge.
• Drug induced or drug abuse related instances of saddle nose occur due to sniffing cocaine or heroin. The sniffing process causes development of holes or gaps in the septum, thereby resulting in the nasal deformity.
• Nasal trauma or previous surgeries of nose are a common cause of saddle nose. People who have undergone rhinoplasty have been found to suffer from collapse of nasal bridge. Similarly, direct trauma to the bony or cartilaginous section of the septum can destroy those parts and deform the nose structure.
• Inflammatory and autoimmune diseases like relapsing perichondritis or Wegner’s disease can cause saddle nose. The former is marked by varied medical issues, including destruction or damage of cartilaginous nasal structures. Wegener’s granulomatosis disease causes inflammation of small and medium sized blood vessels, which are subsequently attacked by the immune system. Destruction or damage of the nasal septum in this manner is what causes saddle nose.
• Leprosy, syphilis, and other infectious diseases may cause nasal deformities. One of the characteristic features of congenital syphilis, which occurs due to passage of syphilis by infected mother to fetus during pregnancy, is a saddle nose.
• Lethal midline granulomatous disease is a type of T cell lymphoma cancer which causes nasal structure defects. Sometimes, malignant cells in the para-nasal sinuses may spread to the nose and damage the integrity of its structure, thereby causing saddle nose.
• FAS or fetal alcohol syndrome is a condition that causes a variety of birth defects and lower than normal nasal bridge is one of them.

Treatment of saddle nose

• Treatment of saddle nose is dependent on the underlying cause. The most common treatment is surgical correction of nose deformity via nasal reconstructive surgery or a rhinoplasty.
• Surgical treatment of saddle nose may involve any of the different procedures like skin grafting, nasal elevation, rib grafts, silicon droplet technique, septal manipulation, or inferior turbinate surgery.
• Treatment of cleidocranial dysostosis involves parting of upper lateral cartilages followed by installation of spreader grafts, so as to open and keep an acceptable valve angle.
• Corticosteroids and immunosuppressant drugs are used for managing autoimmune disorders
• Congenital syphilis is treated with penicillin and/or other kinds of antibiotics. The success rate of this treatment is limited. Pregnant women should check for syphilis and get treatment so as to prevent complications in unborn baby as well as the mother.