Management of saddle nose deformity in atrophic rhinitis

Abstract

Correction of a saddle nose deformity due to atrophic rhinitis is a formidable task. The thick and puckered skin secondary to long standing disease makes the creation of a dorsal subdermal pocket difficult. On the one hand, these patients tolerate synthetic implants poorly and on the other they show an unusually high rate of absorption of autologous bone graft. Our experience of treating 15 patients with saddle nose defor mity secondary to atrophic rhinitis is presented.

The aetiology and management of atrophic rhinitis

“…Correction of saddle nose deformity and septal perforation in cases of longstanding atrophic rhinitis are formidable tasks. 50 The thick and puckered skin secondary to longstanding disease makes the creation of a dorsal subdermal pocket difficult. These patients do not tolerate synthetic implants well and also show an unusually high rate of absorption of autologous bone grafts.…”

Calvarial bone grafts for augmentation rhinoplasty

“…Long-term follow-up studies show a high extrusion rate (Hiraga, 1980), the sequelae being the so-called 'crucified' noses. Non-biological grafts are also not suited for deformities following atrophic rhinitis (Baser, et al, 1990). Finally the cost of these implants is another limiting factor in our country.…”

“…Rib cartilage provides a large amount of graft material and has little tendency for absorption. This is advantageous in certain clinical situations where the risk of bone absorption is high such as in atrophic rhinitis (Baser, et al, 1990). However, costal cartilage once implanted becomes hard and stiff.…”

Triosite Implants and Fibrin Glue in the Treatment of Atrophic Rhinitis: Technique and Results

“…Beside the abnormal turbulence of air flow in the nasal fossae, causes such as climate and racial factors, 1 ciliostasis provoked by superinfection, 2 autoimmune mechanisms, 3 and reflex sympathetic dystrophy 4,5 have all been suggested. The clinical picture is dominated by progressive atrophy of the nasal and turbinate mucosa, as well as the resorption of the underlying bone, which can sometimes be considerable 6 …”

“…The clinical picture is dominated by progressive atrophy of the nasal and turbinate mucosa, as well as the resorption of the underlying bone, which can sometimes be considerable . 6 Primary atrophic rhinitis has become comparatively rare in the developed countries of the world. However, secondary atrophic rhinitis is becoming more common and is frequently being seen as the consequence of overzealous intranasal surgery causing heavy local mutilation, such as total inferior turbinectomies and disabling nasosinusal surgeries with various synechiae and removal of the turbinates.…”