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At least 19 recordsLinked to original sources
PubMedDate not supplied

The use of lower turbinate bone grafts in the treatment of saddle nose deformities.

Saddle nose reconstruction is based on the use of support grafts to manage aesthetic and functional problems. Bone (calvarial, iliac crest, costal, nasal hump, ulnar, and heterogeneous origin), cartilage (septal, costal, heterogeneous), and synthetic materials (silicon, silastic, polyethylene) were used as support grafts. Three patients have been included in this study to define the surgical management and long-term aesthetic and functional results of patients undergoing rhinoplasty with support grafts for a saddle nose deformity. Open rhinoplasty was employed. Both the lower turbinates were excised and the bone dissected from the soft tissues in two cases and in one case, only mucosa was removed. The amount of support needed was measured by using bone wax. The bone was used shaped in layers, according to the defect, and sutured to each other by vycril suture, and wrapped around by surgicell. The graft was then inserted in its place and fixed with external prolene sutures. Results were satisfactory in both function and aesthetics. Ten to 16-month follow-ups had no complications. Saddle nose surgery basically requires the use of a support graft to repair the nasal dorsum. A lower turbinate bone graft procedure has some advantages: it is cheap and safe, it is ready to use and not time-consuming, there is no donor area and no additional donor site morbidity, and it enlarges the airway and the passage to prevent nasal airway obstruction.

Adult↗
PubMed1996

The traumatic saddle nose deformity: etiology and treatment.

The saddle nose resembles a saddle, i.e., with a concave, often flattened dorsum and an apparent cephalic rotation of the nasal tip. The concavity may be present in the osseous or cartilaginous dorsum, or both. The saddle nose deformity can be divided into congenital, postinfection, postsurgical, and traumatic types. Congenital saddle nose deformity is rare, often accompanying midfacial deficiency malformation syndromes. The advent of antimicrobial therapy has helped restrict the incidence of syphilitic or leprotic saddle nose to the nonindustrialized nations. Postsurgical saddle nose deformity occurs most often as a result of the overzealous septorhinoplasty. The most common type of saddle nose deformity may be traumatic. The authors use Kazanjian and Converse's characterization of the true saddle nose as one in which the bony and/or cartilaginous portions are depressed and the projection of the nose is generally preserved. This article describes the saddle nose deformity and its etiology and proposes a management technique with minimal complications.

Adolescent↗
PubMed1998

Reconstruction of the major saddle nose deformity using composite allo-implants.

The major saddle nose deformity leaves a patient with an obvious aesthetic deficit as well as an equally disturbing functional handicap. Reconstructing the collapsed dorsum and tip and simultaneously restoring nasal function present a formidable challenge which has elicited a wide variety of solutions ranging from the use of a toothbrush handle to split calvarial grafting. As Murakami et al pointed out, the "variability exists to a large extent, because the saddle nose deformity is not a single entity but rather a spectrum of abnormalities." Attempts to categorize saddle nose deformities are useful; however, they often lack the simple impact and clarity of the pre-operative photograph. Moreover, the categorizations have not led to a uniform approach to this complicated problem. Nevertheless, Tardy's classification of minimal, moderate, and major saddle nose deformities provides a helpful framework for discussion of reconstructive options. Minimal deformities demonstrate a supratip depression of 1 to 2 mm and are easily corrected with cartilage or fascial overlays. Moderate saddle nose deformities are characterized by a significant loss of dorsal height as well as columellar retraction and broadening of the bony pyramid. A major deformity demonstrates "all of the stigmata of the moderately saddled nose, only to a more marked degree." In Tardy's opinion, an open approach may be warranted in these cases. We offer one solution to the major saddle nose deformity using a composite allo-implant of porous high-density polyethylene (PHDPE) (Medpor surgical implants, Porex Surgical, Inc., College Park, GA) and purified acellular human dermal graft (Alloderm, Life Cell Corp., TX.). While we readily admit that autogenous tissue is the preferred grafting material, we have encountered patients in whom this is not an option. Major saddle nose deformities typically require more augmentation than stacked septal or auricular cartilage can provide. Additionally, in patients seeking revision rhinoplasty, sufficient donor septal or auricular cartilage is often lacking. Resorption of irradiated cadaveric rib grafts has led us away from this material. Split calvarial bone grafts are our next recommendation for these patients; however, many patients refuse this option. In these patients we have turned to a composite allo-implant of PHDPE and acellular human dermal graft for reconstruction of the collapsed dorsum and tip.

Biocompatible Materials↗
PubMedDate not supplied

Surgical correction of saddle nose deformity.

Persons with saddle nose deformity can benefit from any of various surgical procedures for correction of the defect, and from various materials -- organic or inorganic -- used for filler material. Usually, other nasal defects co-exist and must be corrected at the time of surgery performed for the main deformity. Techniques and guidelines for surgical treatment have been presented. The use of polyamide mesh as filler material in 70 patients has given outstanding good results, which are briefly discussed.

Cartilage↗
PubMed2006

Takayasu's arteritis and saddle nose deformity: a new association.

Aortitis and saddle nose deformity are extremely unusual manifestations of a variety of systemic diseases. The concurrent appearance of these apparently disparate clinical features is a clinical rarity. A case of saddle nose deformity in a patient with confirmed Takayasu's arteritis is presented. The relevant literature is reviewed with reference to the possible differential diagnosis of patients with aortitis and saddle nose deformity.

Adult↗
PubMed1988

"The open sky rhinoplasty" for correction of secondary cleft lip nose deformity, Technique and recent results.

The typical nose deformity after cleft-lip repair still represents great challenge for the plastic surgeon in this field. Many methods have been designed in attempts to correct the deformity, either during primary closure of the lip or as a secondary procedure when growth of the nose is complete. In this paper the author's own technique of secondary rhinoseptoplasty in cleft-lip patients is presented. The different cartilaginous and osseous structures are approached through a transcolumellar incision and the skin of the nose completely reflected upwards. This so-called "open sky view" gives a total perspective on the entire pathology of the cleft-lip nose deformity and makes it possible to correct it accordingly. Emphasis is put on some important surgical manoeuvers. Recent results are presented and the pros and cons of this procedure discussed.

Adult↗
PubMed1998

Use of iliac bone graft for saddle nose deformity.

The reconstruction of the saddle nose deformity presents an arduous task for the reconstructive surgeon. A large variety of graft materials have been used for augmentation rhinoplasty. The modern trend is to prefer autologous material. Iliac bone grafts are extremely suitable for augmenting moderate to severe saddle nose deformity. In our study, autogenous iliac bone grafts were used in the nasal reconstruction of 14 patients. The follow up has been from 1-4 years, with no significant resorption noted during that time. Complication was limited to one hematoma on the donor side.

Adult↗
PubMed1998

Pyoderma gangrenosum producing saddle nose deformity.

Pyoderma gangrenosum affecting the nose is rare and this may lead to diagnostic confusion because of the large differential diagnosis. As diagnosis is made, largely, on the basis of exclusion the treatment of pyoderma gangrenosum may be unduly delayed. The condition is often disfiguring, particularly following inappropriate surgical intervention, and early diagnosis is therefore important. We present a case of pyoderma gangrenosum managed initially in the community with minor surgery and resulting in the rare complication of saddle nose deformity.

Aged↗
PubMed2004

Three-step reconstruction of complex saddle nose deformities.

OBJECTIVE: To evaluate a reproducible surgical technique for augmentation rhinoplasty of complex saddle nose deformities, which are characterized by substantial loss of nasal structural support and result in multiple nasal abnormalities. DESIGN: Case series and surgical outcome study. SETTING: Tertiary referral center. PATIENTS: A total of 43 patients (32 female and 11 male; mean +/- SD age, 36 +/- 12 years) with complex saddle nose deformities and extensive loss of nasal volume, shape, and support who underwent reconstructive surgery between 1997 and 1999. INTERVENTION: A standardized 3-step surgical procedure using autogenous costal cartilage. MAIN OUTCOME MEASURES: Assessment of additional nasal abnormalities, graft recipient site conditions, postoperative complications, postoperative analgesic consumption, and subjective outcome assessed with a standardized telephone interview 2 years following surgery. RESULTS: Besides nasal abnormalities characteristic of complex saddle nose deformities, several additional nasal abnormalities were frequently encountered. Forty of the 43 patients had undergone previous septorhinoplasty, 26 of whom through multiple procedures. One transplant extrusion was recorded, which required revision surgery. In 8 patients, minor surgical corrections were performed. Nasal airflow was judged satisfactory or good by 30 of the 37 patients who were contacted by telephone and aesthetic appearance was considered good by 17, satisfactory by 10, and unsatisfactory by 10. CONCLUSIONS: Three-step nasal reconstruction with costal cartilage is indicated in severe saddle nose deformities. It is a comparatively reliable surgical procedure yielding satisfying results even in patients with severe deformities and unfavorable recipient site conditions.

Adult↗
PubMed1990

Management of saddle nose deformity in atrophic rhinitis.

Correction of a saddle nose deformity due to atrophic rhinitis is a formidable task. The thick and puckered skin secondary to long standing disease makes the creation of a dorsal subdermal pocket difficult. On the one hand, these patients tolerate synthetic implants poorly and on the other they show an unusually high rate of absorption of autologous bone graft. Our experience of treating 15 patients with saddle nose deformity secondary to atrophic rhinitis is presented.

Adult↗
PubMed1999

A case of reconstruction of saddle nose deformity in leprosy.

A case of reconstructive surgery for saddle nose deformity is presented in this paper. A 22 year-old Bengali female who had completed WHO/MB regimen for 27 months underwent reconstructive surgery for saddle nose deformity. Since a saddle nose is one of the symbols of leprosy, it often causes serious psychological and social troubles to patients. This happens more often when the patient is a young unmarried woman. In this case the saddle nose seemed to be very serious. After being discharged from hospital she got married and had a baby. This operation gave the patient great relief to live in the community, because she no longer had serious visible evidence of leprosy on the body. Though the correction of the deformity without any dysfunction does not always have priority over other surgeries at a busy leprosy control project in Bangladesh, it has merit both in patients themselves and in the society around them because it leads to the elimination of the stigma of leprosy.

Adult↗
PubMedDate not supplied

[Surgical correction of external nose deformities].

During surgical elimination of external nose deformation biologically inert prostheses were used. In the post-operative period low-intensity laser therapy was applied. No adverse effects of corundum ceramics were noted. The procedure of posterior tamponade was modified to ensure complete isolation of the nasopharynx during surgical manipulations on the external nose skeleton.

Adolescent↗
PubMed2006

Management of unilateral cleft lip nose deformity, with retracted ala of the noncleft side.

BACKGROUND: Traditionally, the goal of management of unilateral cleft lip-cleft nose deformity has been nasal symmetry, with improved nasolabial and nasofacial relationships and the noncleft side as the reference point. However, symmetry does not always ensure an aesthetically desirable form. The retracted ala is characterized by an alar rim to the long axis of the nostril distance greater than 2 mm on lateral view of the nose. In the management of unilateral cleft lip nose deformity in a patient with a retracted ala of the noncleft side, a simple correction of the deformity symmetric to the noncleft side results in bilateral alar retraction, an aesthetically undesirable result. METHODS: The authors present eight cases of managing unilateral cleft lip deformities with retracted alae of the noncleft side between January of 2003 and October of 2004. RESULTS: Correction of alar retraction of the noncleft side with or without the correction of cleft lip nose deformity yielded better aesthetic results that were maintained throughout the follow-up period. CONCLUSIONS: Aesthetic surgery is the natural evolution of reconstructive surgery; in the reconstruction of selected unilateral deformity, the concept of "as symmetric to the contralateral side as possible" should be changed to the pursuit of an aesthetically pleasing appearance of both sides.

Adolescent↗
PubMed1998

Nasal sill augmentation in adult incomplete cleft lip nose deformity using superiorly based turn over orbicularis oris muscle flap: an anatomic approach.

Adult incomplete cleft lip nose deformity is not uncommon in India. Poverty, ignorance, and parental neglect account for its late presentation. Besides the classical features of cleft lip nose deformity, the constant findings observed in this patient population have been a widened and depressed nasal sill. This is attributable to the sparse, hypoplastic, and abnormally orientated orbicularis oris muscle in the region of the sill. Failure to restore the nasal sill symmetry by suitably augmenting the sill frequently leads to unsatisfactory and asymmetric results. However, in the literature, satisfactory restoration of the nasal sill has not been given the importance it deserves while performing cleft lip rhinoplasty. We present a method of augmenting the depressed nasal sill in cases of adult incomplete nose deformity using a superiorly based orbicularis oris muscle flap, which is harvested from the soft tissues between the apex of the cleft and the nostril sill. Following de-epithelialization of the overlying skin, the exposed muscle is raised as a superiorly based flap after dissecting it from the underlying mucosa. It is folded, turned over, and tucked into the nasal sill base and anchored to the anterior nasal spine to give the desired augmentation. Satisfactory results have been obtained in 18 cases of nasal deformity associated with incomplete cleft lip. In our opinion, this technique offers a simple and effective method of augmenting the depressed sill by utilizing locally available tissues and without the need for procuring autologous tissue from distant sites.

Adolescent↗
PubMed1990

Open reverse-U incision technique for secondary correction of unilateral cleft lip nose deformity.

A new technique for secondary correction of unilateral cleft lip nose deformity is described. It is a combination of Tajima's reverse-U incision and Rethi's columella-alar rim incision techniques. It gives a markedly increased exposure under better direct vision and enables easier and more accurate handling of the nasal framework in secondary correction of the unilateral cleft lip nose deformity.

Adolescent↗
PubMed2004

[Correction of congenital of the lateral nose deformities].

Immediate and remote results of perennial use of most popular correction methods in different types of congenital deformations of nose end (wide end -- according to J. Converse; prolonged end -- according to D. Armstrong and protruded end -- according to F. Burian) were analyzed and their drawbacks disclosed. The authors presented their own new techniques.

Adult↗
PubMed1993

Osteocartilaginous flap technique for acquired and congenital saddle nose deformities.

This paper illustrates the objective possible applications of the osteocartilaginous flap technique in solving the functional and aesthetic problems associated with saddle nose deformities, the pathogenesis of which essentially relates to: (1) congenital saddle noses; (2) post-traumatic saddle noses; and (3) saddle noses resulting from previous surgery on the septum. This technique is suggested as an alternative to a combination of other methods (such as septoplasty, bone, or cartilage grafts) to restore the inhalatory function of the internal nasal valve and the integrity of the nasal support structures using locally available tissues. The authors prefer to use this technique in the treatment of serious congenital or acquired saddle nose deformities and to assign composite grafts a supplementary function only. The different stages of this surgical procedure are analyzed and the results are assessed during short- and medium-term follow-up.

Adult↗