Rhinoplasty: septal saddle nose deformity and composite reconstruction.

BACKGROUND: Saddle nose is one of the most challenging deformities in all of rhinoplasty surgery. Recent advances in aesthetic reconstructive surgical techniques warrant discussion of this subject.
METHODS: A review of saddle nose cases revealed that an important subgroup exists, which has been designated the septal saddle nose deformity. The pathophysiology was weakening or loss of septal support, and not the classic dorsal overresection. A prospective study of 25 consecutive cases was then completed, with emphasis on analysis, classification, and treatment.
RESULTS: Prior attempts at classification have emphasized cause. The author's study indicated that the majority of cases had multiple causes, with acute trauma followed by a complete septorhinoplasty the most common, as opposed to simple fracture reduction. In addition, 10 of 25 cases were true secondary saddle nose deformities. Classification was divided into types I through V based on presenting deformities and method of treatment. A new method of composite reconstruction was devised that allows one to construct a deep structural foundation layer that is then superimposed with an aesthetic layer.
CONCLUSIONS: Septal saddle nose is an important entity that must be recognized and treated, especially when it is progressive. Composite reconstruction offers a unique solution to saddle nose deformity, as it is a flexible method of restoring structural support and aesthetic contour.