Saddle nose deformity repair – structured approach
Reviewed by Sangeeta Maini and Bhaskar Ram

We often come across saddle noses in our specialist rhinology clinics. The saddle nose deformity represents collapse of the cartilaginous and / or bony nasal support structures resulting in dorsal height loss. Acquired cases are due to trauma or surgery or secondary to septal perforation. Congenital cases are seen in Down, Binder and Williams syndromes. Management of saddle noses can be quite challenging. I found the Daniel and Brenner classification highlighted by the senior author for assessing the severity of the saddle nose deformity of practical use. This classification system describes not only the complexity of the saddling but also recommends a guided treatment approach. The surgical techniques recommended by the author include dorsal augmentation, midvault reconstruction, reconstruction of the nasal framework, nasal tip augmentation, columellar augmentation and reconstruction of nasal soft tissue and composite reconstruction. These surgical tips are very helpful to manage these complex cases.

Functional and Cosmetic Considerations in Saddle Nose Deformity Repair.
Pham TT, Winkler AA, Gadkaree SK.
OTOLARYNGOL CLIN NORTH AM
2025;58(2):325–41.