Complications of Rhinoplasty - Page 12

Specific Complications of the Nasal Vault

Saddle Nose
Saddle nose refers to the appearance of the nose after loss of support of the nasal vault with subsequent collapse (Fig. 39–5). This deformity has been described after overresection of the septum, with failure to preserve an adequate L strut. A mini-mum of 15 mm of cartilage is recommended as a rule of thumb; if a dorsal hump resection is also planned, this must be accounted for in planning adequate L strut for nasal sup-port. Other causes of saddle-nose deformity include septal hematoma, septal abscess, and severe nasal trauma. Excessive dorsal hump resection also leads to saddle-nose deformity.

Onlay grafting can effectively camouflage and correct mild and moderate saddle deformities. Septal or auricular cartilage in single or multiple layers is commonly used effec­tively. Severe saddle-nose deformity may require major reconstruction with cantilevered cartilage or bone grafts.

Inverted-V Deformity
In inverted-V deformity, the caudal edges of the nasal bones are visible in broad relief (Fig. 39–5). Inadequate support of the upper lateral cartilages after dorsal hump removal can lead to inferomedial collapse of the upper lateral cartilages and an inverted-V deformity. Inadequate infracture of the nasal bones is another significant cause of inverted-V deformity.

When executing hump excision, it is helpful to preserve the underlying nasal mucoperichondrium (extramucosal dis­section), which provides support to the upper lateral carti­lages and helps decrease the risk of inferomedial collapse of the upper lateral cartilages after hump excision. When undertaking osteotomies after hump excision, appropriate infracture and narrowing of the bony vault must be achieved.

Figure 39–5 Patient with large septal perforation, loss of cartilaginous nasal support, and sub­sequent severe saddle-nose deformity. On frontal view the caudal aspect of the patient's nasal bones is visible in broad relief, demonstrating the inverted-V deformity.

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