Saddle nose deformity: etiology, prevention, and treatment; augmentation rhinoplasty with polyamide.

Abstract

AbstractSaddle nose deformity is characterized by an abnormally concave dorsum with an apparent upward tilting of the nasal tip; the osseous or the cartilaginous vault or both regions may be affected. Over the years, the etiology has changed: formerly syphilis was a major cause of destruction of the nasal supporting structures; today, mechanical and surgical trauma to the nose, fractures, septal hematoma, and racial features are the primary causes of saddle nose deformity; the incidence is increasing as fractures from high‐speed automobile accidents increase, and as Orientals and Negroes seek elective nasal plastic procedures. Prevention involves early treatment of nasal injuries in childhood, which affects the growth centers in the nose; treatment of hematoma that may follow injury at any age; avoidance of excessive hump removal during rhinoplastic operations. Treatment of saddle nose deformity, either for physiologic and/or for cosmetic reasons, is augmentation rhinoplasty. Filler materials range from human living or cadaveric tissue — autografts or homografts of bone or cartilage —, heterografts — animal cartilage or processed bone; and inorganic implant materials — metals, synthetic alloplastics. A brief review of the materials and their use during the years gives evidence that the “ideal” material is still to be found. The author's experience with the alloplastic, polyamide mesh, in 30 patients within the last two years has led to initial satisfactory results in 27 patients and subsequently satisfactory results in two patients; one patient awaits a reimplantation. In the three patients who had initial failures there was underlying infection. In all 30 patients the polyamide mesh was well tolerated by the human host; there were no foreign body reactions, no rejections. It was found that the host tissues actually invaded the implant, giving it stability and incorporating it into the host tissues. No implant became displaced. The polyamide mesh has approximately the same flexibility as the host tissues, and the naturally semimobile part of the nose can be readily moved around, providing a repair that approaches the normal nose. The cosmetic effects are entirely satisfactory, and the author believes that polyamide mesh is a valuable adjunct to augmentation rhinoplasty and expects to continue to use it for correction of saddle nose deformity and also to document the results over a long postoperative period. All augmentation materials have advantages and disadvantages; these are summarized in Table I.