[Skip to Content]
[Skip to Content Landing]

Extended Butterfly Graft for Functional and Cosmetic Correction of Saddle Nose Deformity

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

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.

Please finish quiz first before checking answer.

You answered correctly!

Read the answer below and download your certificate.

You answered incorrectly.

Read the discussion below and retake the quiz.

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

Survey Complete!

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

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 (mbren@med.umich.edu).

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.

References
1.
Daniel  RK, Brenner  KA.  Saddle nose deformity: a new classification and treatment.  Facial Plast Surg Clin North Am. 2006;14(4):301-312, vi. vi.PubMedGoogle ScholarCrossref
2.
Clark  JM, Cook  TA.  The ‘butterfly’ graft in functional secondary rhinoplasty.  Laryngoscope. 2002;112(11):1917-1925.PubMedGoogle ScholarCrossref
3.
Friedman  O, Cook  TA.  Conchal cartilage butterfly graft in primary functional rhinoplasty.  Laryngoscope. 2009;119(2):255-262.PubMedGoogle ScholarCrossref
4.
Stucker  FJ, Hoasjoe  DK.  Nasal reconstruction with conchal cartilage. Correcting valve and lateral nasal collapse.  Arch Otolaryngol Head Neck Surg. 1994;120(6):653-658.PubMedGoogle ScholarCrossref
5.
Loyo  M, Gerecci  D, Mace  JC, Barnes  M, Liao  S, Wang  TD.  Modifications to the butterfly graft used to treat nasal obstruction and assessment of visibility.  JAMA Facial Plast Surg. 2016;18(6):436-440.PubMedGoogle ScholarCrossref
6.
Friedman  O, Coblens  O.  The conchal cartilage butterfly graft.  Facial Plast Surg. 2016;32(1):42-48.PubMedGoogle ScholarCrossref
7.
Chua  DY, Park  SS.  Alar batten grafts.  JAMA Facial Plast Surg. 2014;16(5):377-378.PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Topics
State Requirements