Correction of saddle nose is a challenging issue. The technique varies according to the severity of saddle and septum status. Slight depression of the dorsum with intact septal support is mostly corrected with dorsal onlay graft. When the septal support is poor and sadlde is severe, the septum needs reinforcement so that dorsal graft does not distort or sink. Reinforcing the septum includes batten graft, spreader graft, and septal extension graft. Rarely, subtotal or total septal reconstruction or replacement is necessary. When septum reinforcement is necessary, rib cartilage is the best choice. Due to its ample amount and rigidity, autologous rib cartilage is the best graft material for most moderate to severe deformity patients.
This lady in below photos had nasal deviation, hump nose, and tip ptosis with breathing difficulty. Septum was corrected first, and this made the lower 2/3 of the nose straight. Hump was not resected but rasped with Piezotome and this did not breach the keystone area, which made spreader grafts unnecessary.Bilateral osteotomies with Piezotome made her bone straight. Together with septum correction and effective osteotomies, her nose became straight from the frontal view. Tip was modified with sutures and onlay graft only. No strut or septal extension graft was used and this made the tip soft even after considerable amount of rotation and projection increase. Radix was augmented with bruised cartilage. Overall, she could breath much better after surgery and her nose became more harmonious and feminine.
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