March 29, 2025 
The term “saddle nose” refers to a condition where the cartilaginous or bony septum, or both, are lower than the natural profile line and closer to the face.
Saddle nose is one of the most common types of nasal deformity, resulting from the destruction of the nasal cartilage or bony structure.
Historically, saddle nose was a characteristic sign of congenital syphilis and could also be caused by leprosy.
Nowadays, bony septum involvement in saddle nose is rare, and it is usually caused by trauma to the middle of the face.
Cartilaginous septum involvement is a more common concept for nasal surgeons.
Depression of the cartilaginous part of the nose often occurs due to excessive removal of septal cartilage during a septoplasty procedure.
If the flaps covering the cartilage are also torn, skeletal support diminishes due to contraction of the healing flaps.
In this type of nasal deformity, both the form and function of the nose are almost equally affected. The primary goal of surgery to correct saddle nose is usually to restore the nose’s previous shape.
The causes of saddle nose can be classified as follows:
1. Congenital (rare).
2. Trauma: Injuries that lead to hematoma or abscess formation in the septum, eventually causing septal necrosis and resulting in an “open roof” appearance.
3. Excessive removal of septal cartilage during a septoplasty procedure.
4. Septal perforation, leading to dorsal cartilage depression.
5. Diseases such as leprosy, syphilis, and cutaneous leishmaniasis.
6. Ethnicity (more common in non-Caucasian races).
7. Wegener’s disease and cocaine use.
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