The saddle nose deformity is caused by a loss structural support involving the cartilaginous and/or bony nasal vault.
Features of a saddle nose:
(1) loss of septal integrity and support
(2) depression and splaying of the middle vault
(3) cephalic overrotation of the nasal tip
(4) decreased vertical projection, with concave nasal dorsum
(5) retraction of the columella
(6) widening of the nasal base
(7) difficulty in nasal breathing due to impaired functioning of the internal and external nasal valves
The loss of structural support can be demonstrated using the septal support test, performed by applying pressure to the supratip area. Weakness of the structural support is associated in collapse under the pressure ("positive").
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