Preservation Rhinoplasty in the Saddle Nose: The Reverse Spare Roof Technique

Overview

Saddle nose deformity is loss of bridge height from a substantial decrease in the cartilage or bone framework, and it follows a range of nasal conditions. The authors state most cases are secondary to surgery or trauma, though congenital causes exist. Repair is described as one of the most difficult problems in nasal surgery because it requires long term structural support without sacrificing appearance.

Sections of note

• Technique introduction; the abstract reports no patient numbers, no outcomes, no complication rates and no follow up.
• Various materials have been used to restore nasal contour, with the patient's own cartilage the most common.
• Septal cartilage is described as ideal but usually insufficient except in mild cases.
• Ear and rib cartilage grafts are therefore the most used in moderate and severe saddling.
• Augmentation rhinoplasty is noted as common in patients whose noses naturally lack bridge projection.
• The stated purpose is to introduce the reverse spare roof technique and its use in both saddle nose correction and augmentation.
• The author states this is the first technique applying preservation rhinoplasty principles to these problems.

What it means for a patient

• Saddle nose means the bridge has collapsed inward, most often after previous surgery or injury.
• The amount of cartilage available determines the graft source, and severe cases generally require ear or rib.
• The technique is described but no results are reported, so its effectiveness is unknown.
• The claim of being first is the author's own assertion.

Why this paper matters

Preservation techniques were developed for reducing humps, and applying them to a nose that has already lost height is a different problem. This article proposes that extension. Whether preservation principles hold up in a collapsed bridge has not been tested.

Terms

• Saddle nose deformity: collapse of the bridge, leaving a dip in the profile.
• Preservation rhinoplasty: keeping and repositioning existing structures rather than removing and rebuilding.
• Cartilaginous vault: the cartilage part of the nasal framework.
• Conchal cartilage: cartilage taken from the bowl of the ear.
• Augmentation rhinoplasty: surgery that builds the nose up rather than reducing it.