Download PDF
Facial Plast Surg 2022; 38(05): 488-494
DOI: 10.1055/a-1803-6341
Original Research

Correction of the Saddle Nose Deformity Using the “Push Up” Technique

Dean M. Toriumi
1   Department of Otolaryngology-Head & Neck Surgery, Rush University Medical Center, Chicago, Illinois
2   Private Practice, Chicago, Illinois
,
Milos Kovacevic
3   Private Practice - Facial Plastic Surgery, Hamburg, Germany
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

The saddle nose deformity typically occurs after the loss of underlying septal support with loss of projection of the middle nasal vault. This creates a saddling effect as the upper lateral cartilages contract and forms a dip in the profile. The saddle nose deformity can occur from many different etiologies, including septal hematoma, fracture of the septum after trauma, disruption of the dorsal L-strut support after septoplasty, and metabolic disorders resulting in the loss of septal support. In most cases, the nasal bones remain in their native position creating a discrepancy in dorsal height and deformity. Correction of the saddle nose deformity can be performed using one of the two primary approaches. The most basic option is to simply fill the defect with a cartilage onlay graft (solid graft, diced cartilage and fascia, and so on) to create a normal dorsal line. This approach can be effective in many cases. Over time, the onlay graft may descend and create deformity or become visible. The other approach involves opening the middle nasal vault, placing spreader grafts, and reconstituting the dorsal L-strut, performing septal reconstruction or extracorporeal septoplasty. In this paper, we present our technique of repairing the saddle nose deformity using a “push up” method that preserves the middle vault anatomy and reconstitutes the proper projection of the middle-third of the nose.

Keywords

rhinoplasty - dorsal preservation - saddle nose - push up - rib harvest


Publication History

Accepted Manuscript online:
21 March 2022

Article published online:
04 October 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Daniel RK. The role of diced cartilage grafts in rhinoplasty. Aesthet Surg J 2006; 26 (02) 209-213
    CrossrefPubMedGoogle Scholar
  • 2 Toriumi DM. Subtotal reconstruction of the nasal septum: a preliminary report. Laryngoscope 1994; 104 (07) 906-913
    CrossrefPubMedGoogle Scholar
  • 3 Gubisch W. Extracorporeal septoplasty for the markedly deviated septum. Arch Facial Plast Surg 2005; 7 (04) 218-226
    CrossrefPubMedGoogle Scholar
  • 4 Durbec M, Disant F. Saddle nose: classification and therapeutic management. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131 (02) 99-106
    CrossrefPubMedGoogle Scholar
  • 5 Daniel RK, Palhazi P. Rhinoplasty: An Anatomical and Clinical Atlas. Heidelberg: Springer 2018
    PubMedGoogle Scholar
  • 6 Ferraz MBJ, Zappelini CEM, Carvalho GM, Guimarães AC, Chone CT, Dewes W. Cirurgia conservadora do dorso nasal—a filosofia do reposicionamento e ajuste do septo piramidal (SPAR). Rev Bras Cir Cabec¸a Pescoc¸o. 2013; 42: 124-130
    PubMedGoogle Scholar
  • 7 Ferriera MC. Spare roof technique. In Daniel RK, Palhazi P, Saban Y, Cakir B. eds. Preservation Rhinoplasty. Third Ed. Septum publishing; 2020
    Google Scholar
  • 8 Personal communication Wilson Dewes.
    PubMed
  • 9 Toriumi DM. Subdorsal cantilever graft for elevating the dorsum in ethnic rhinoplasty. Facial Plast Surg Aesth Med 2022; 24 (03) 143-159
    CrossrefPubMedGoogle Scholar