One of the lectures I gave and one of the topics for discussion at both meetings was treatment of the saddle nose.  It is clear that all of us find this a difficult procedure.  Unfortunately currently there is no perfect material to use.  Artificial grafts risk infection and extrusion and patients own tissue for grafting requires surgery to borrow cartilage from the ear or the rib and involves difficulties of carving to the right shape.  I and other speakers agree that in most cases surgery requires reconstruction of the nasal septum and for the severe cases use of rib cartilage.  Often patients with saddle noses have loss of the normal angle between the nasal tip and lip and I presented my thoughts explaining as to why this is not a problem with the bone of the upper jaw but loss of septum length.  I think the caudal extension graft is very significant in reconstructing this area.  The use of rib cartilage I feel is appropriate for when tissue loss is severe only.