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Depressions of the nasal bridge may be localized on the bone, cartilage or both. The latter are the most severe cases constituting the saddle-nose deformity, which may lead to various serious functional consequences. A severely depressed nasal dorsum is usually secondary to trauma or infection. In children it may also be caused by a multitude of genetic or environmental factors. A wide variety of congenital disorders or syndromes, birth defects, such as the fetal alcohol syndrome, and infectious diseases, such as congenital syphilis may be included in the pathogenetic factors. The most commonly encountered congenital syndromes with a depressed nasal bridge in the pediatric orthopaedic practice are cleidocranial dysplasia, children with neurodevelopmental delay, achondroplasia, Conradi-Hünermann-Happle syndrome, Cornelia de Lange syndrome, osteogenesis imperfecta and Klippel-Feil syndrome. The evaluation and management of patients with a depressed nasal bridge requires a multidisciplinary team. The pediatric orthopaedic surgeon is usually not involved in the primary treatment of these children. However, he may be helpful towards making an early referral, indicating an undiagnosed clinical sign, to establish a syndromic diagnosis and may also be involved in the treatment of coexisting bone disorders.

Depressed Nasal Bridge in Pediatric Orthopaedic Practice: A Review