Dorsal Preservation Surgery: A Novel Modification for Dorsal Shaping and Hump Reduction

Abstract

Background A new technique for dorsal preservation rhinoplasty is introduced which minimizes recurrent hump deformity. Objectives A novel Dorsal Roof Flap (DRF) technique is presented for modifying the nasal hump and dorsum while reducing morbidity. Methods Twenty-two primary and 3 secondary rhinoplasty patients had one of two types of nasal dorsal roof flaps (DRF) depending on hump composition. A triangular roof flap was created using two incisions from W-point to lateral Keystone junction in cartilaginous humps (DRF-c), and to the nasion in osseocartilaginous humps (DRF-oc). Then, septal strip excisions were done to lower the profile followed by nasal base narrowing. The DRF was then lowered to the desired profile line, any excess lateral wall height is trimmed, and then the DRF is sutured to the upper lateral cartilages. Preoperative and postoperative nasolabial (NLA) and nasoglabellar angles (NGA) were measured on the photos. Results Mean follow-up was 10.3 [4.41] months (range, 6-20 months). 22 humps were V-shape and 3 were S-shape. The composition of the hump was cartilaginous in 5 cases, bone in 7 cases, and combined in 13 cases. A DRF-c was used for the 5 cases with a cartilaginous hump and a DRF-oc was used in the other 20 cases. There were no complications observed in the follow-up period and thus no revisions. Conclusions The Dorsal Roof Flap Technique allows preservation of the nasal dorsum and elimination of the dorsal hump while minimizing hump recurrence.

State of the Evidence for Preservation Rhinoplasty: A Systematic Review

“…3,7,12,[21][22][23][24][25][26][27][28][40][41][42] The remaining references include subjective or photographic evaluation of cosmetic and/or functional outcomes as well as analysis of complication rate, postoperative dorsal hump recurrence, and revision rates. 1,2,8,10,11,[14][15][16][17]20,33,35,37,39,[45][46][47][48] Overall, the DPR techniques are reported to have a complication rate ranging from 0 to 25.80% with the majority of reported complications being minor. 1,9,10,12,13,[16][17][18][23][24][25][26][27]30,34,35,3...…”

“…1,2,8,10,11,[14][15][16][17]20,33,35,37,39,[45][46][47][48] Overall, the DPR techniques are reported to have a complication rate ranging from 0 to 25.80% with the majority of reported complications being minor. 1,9,10,12,13,[16][17][18][23][24][25][26][27]30,34,35,37,39,40,44,46 Reported postoperative dorsal hump recurrence rates ranged from 0 to 36.9% with the most dorsal hump recurrence occurring following the classical septum pyramidal adjustment and repositioning (SPAR) approach in complex rhinoplasty cases. 1,2,7,13,[15][16][17][18][20]…”

“…Please see the lateral crural preservation group included in ►Table 4 for all reference details. 1,10,18,25,34,46, To our knowledge, there are no references that directly compare lateral crural preservation techniques to conventional rhinoplasty. The highest level of evidence (level II) is currently available for LCS, LCO, and TING techniques.…”

“…Please see the soft-tissue preservation group included in ►Table 3 for all reference details. 1,7,10,12,17,18,27,28,34,35,41,[45][46][47][49][50][51] No studies included in this category directly compare preservation techniques to conventional structural rhinoplasty. The highest level of evidence is available for the subdorsal septal approach proposed by Qaradaxi et al 34 The goal of this technique is nasal hump reduction with minimal dissection of the soft-tissue envelope of the nasal dorsum, which encompasses all three preservation techniques well.…”

Be a Voice, Not an Echo: A Comment on When a “Novel” Technique Is Not Such

“…We read with interest the paper by Tuncel et al entitled “Dorsal Preservation Surgery: A Novel Modification for Dorsal Shaping and Hump Reduction.” 1 Among the many recent variations of preservation techniques, this “novel” modification is essentially a hybrid technique that splits the middle vault and allows proper suture fixation to prevent potential hump relapse.…”