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We present a case of a middle-aged woman with saddle nose deformity after prior rhinoplasty. The patient related concerns of chronic nasal obstruction, which had worsened in the years since her procedure. She was also concerned about the appearance of her nose. She wished to have the deformity corrected and to have normal breathing restored.
Examination demonstrated severe nasal saddling with collapse of the cartilaginous dorsum and a deficient bony dorsum due to prior overresection. In addition, the upper lateral cartilages demonstrated an inverted-V deformity. Her nasal tip was overrotated, and the lower lateral cartilages (LLCs) were weakened, producing a pinched nasal deformity (Figure 1). Findings of the Cottle maneuver were positive. Marked internal nasal valve collapse was present, causing substantial functional deficit. Much of the septal cartilage had been resected.
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Severe nasal saddling, collapse of cartilaginous dorsum, and deficient bony dorsum due to prior overresection
C. Extended butterfly graft
Saddle nose deformity results from loss of support structures that maintain the middle nasal vault. The deformity is associated with collapse of the dorsal septum and ULCs. As the present case demonstrates, saddle nose is a progressive deformity, increasing in severity over time as the weakened midline structures buckle and the midvault collapses. Saddle nose deformity represents a substantial reconstructive challenge, and it is frequently associated with a dysfunctional internal nasal valve. Severe cases like the one presented here may include deficits of the bony dorsum in addition to loss of support of the mid vault and internal nasal valve.1
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Corresponding Author: Michael J. Brenner, MD, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, University of Michigan, 1500 E Medical Center Dr, SPC 5312, 1904 Taubman Center, Ann Arbor, MI 48109-5312 (email@example.com).
Published Online: October 3, 2019. doi:10.1001/jamafacial.2019.0815
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information. We also thank Jennifer Nelson, MD, for the conception and design of Figure 1. They received no compensation for their contributions.
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