Management of Combined Deviated and Saddle Nose

Abstract

Objective To present the surgical algorithm and key maneuvers that were successfully applied in the correction of post-traumatic combined deviated and saddle nose deformity. Methods 25 consecutive patients who had undergone primary rhinoplasty in a tertiary hospital for a post-traumatic combined deviated and saddle nose were enrolled in the study. The patterns of deformity, surgical maneuvers applied, surgical results, and complications were analyzed with chart review, interview with patients, and evaluation of the patient photographs. Mean follow-up period was 19 months. Results Deviated nose combined with minor saddling that had sufficient septal support was most commonly encountered (n=18, 72%) and were treated by straightening the nose and septum, followed by simple onlay grafts. Five patients had combined deviated and saddle nose with loss of septal support (n=5, 20%) and needed septal replacement to facilitate other procedures for correction. In 2 patients (8%) showing deviation with generalized saddling with loss of septal support, an integrated dorsal graft with columellar strut was performed, bypassing the major septal reconstruction. The key maneuvers for correction were septal reconstruction (92%), bilateral osteotomies (84%), and dorsal onlay grafts (100%). No major complications were found. Objective evaluation showed complete correction of the deviation and saddling in 84%, persistent deviation but less than before surgery in 12%, mild residual saddle in 4%. Conclusions Establishing a straight and firm septum supporting the overlying nasal structures is the most important step in correction of post-traumatic combined deviated and saddle nose.