What Causes Saddle Nose?

Is a saddle nose the same as a pug nose and what causes it?

Some people have a slight upturn on the tip of their nose that is natural and attractive. When the appearance is more pronounced, it may be the result of a collapse or depression of the nasal bridge. This often looks very much like a saddle when looking at the profile, which led to it being described as a saddle nose deformity, as well as perhaps the more common “pug nose” or “boxer’s nose”. The severity can range from slight, which is barely noticeable, all the way to extreme, requiring nasal surgery.

Saddle Nose Causes

While the majority of cases of saddle nose are due to some sort of trauma, there are other causes. The most common causes for saddle nose, include:

• Nasal Trauma – any sort of injury or trauma to the nose can damage the septal cartilage along the bridge and compromise important support structures. Athletes, especially in sports with extreme physical contact, like boxing and hockey, are prone to these kinds of injuries. Untreated, the blood supply can be disrupted and the cartilage can actually disintegrate.
• Surgical Causes – rhinoplasty surgery that is overaggressive can be a contributing cause if excess cartilage is removed from the nose in an attempt to reduce the height of the bridge. There may no longer be sufficient bone and cartilage which can result in the collapse of the middle portion of the nasal bridge.
• Intranasal Cocaine Usage – cocaine causes vasoconstriction, which is a narrowing of the blood vessels. Diminished blood supply to the nasal septum can lead to the cartilage deteriorating to the point where there is a septal perforation, or hole. If cocaine usage is stopped before there is permanent damage, the blood vessels can recover. Once there is a perforation of the cartilage, however, the damage will not heal on its own, and there is a serious possibility of collapse.
• Medical Causes – several medical conditions can result in damage to the nasal septum leading to a saddle nose:
  • Wegener granulomatosis – rare, multisystem autoimmune disease that causes inflammation of the blood vessels.
  • Relapsing polychondritis – a rare multi-systemic disorder, characterized by recurring episodes of painful and destructive inflammation of the cartilage and other connective tissues in many organs, including the nose.
  • Leprosy (Hansen disease) – a chronic infectious disease that affects, among other areas, the lining of the nose.
  • Congenital syphilis – disabling and often life-threatening infection passed to infants from the mother leading to issues like saddle nose, which can be apparent at birth or appear later.
  • Ectodermal dysplasia – rare, inherited and multisystem disorder that, among other things, can cause atrophic rhinitis, which is the chronic inflammation of the nasal passages. This inflammation can lead to the kind of damage that results in saddle nose.

Treatment for saddle nose begins, of course, with treating or managing any underlying cause. Plus, if the saddle nose is severe enough to cause difficulty breathing or has an impact aesthetically, surgery will likely be the next step. This may be revision rhinoplasty if the damage is associated with an initial surgery that led to the collapse of the nasal septum. It will be important, whatever the reason for saddle nose surgery, to consult with an experienced rhinoplasty surgeon familiar with saddle nose procedures.Experienced, board certified and dedicated, Dr. Geoffrey Tobias was recognized 12 times as “best in his field” by New York Magazine. When you need a highly-skilled and experienced rhinoplasty surgeon, you could not make a better decision than to request a consultation with Dr. Tobias. To start that process, simply click here.