Narrowing and Operated Appearance of the Middle Nasal Third after Hump Resection without Middle Vault Reconstruction

Abstract

reserving a natural appearance of the nasal dorsum after a profile reduction continues to be a challenge. The well-understood deformities contributing to an undesirable postoperative appearance of the resected dorsum are narrowing, irregularities, and depressions of the nasal sidewall, resulting in the shape of an inverted V. These deformities result from disruption of the attachments between the upper lateral cartilages and the dorsal septum. 1-3 More than six decades ago, the push-down technique was described: the dorsum was lowered with full preservation of the original dorsal continuity. 4 The concept was later modified by resecting bony wedges of the frontal process of the maxilla, 5 but the amount of dorsal reduction attainable with this let-down technique was felt to be insufficient at times. 6 Further modifications of the concept were the spare-roof technique, lowering the cartilaginous and bony dorsum after resection of a strip of the cartilaginous septum, 7,8 and the disarticulation technique

Cosmetic Rhinoplasty

“…Nasal bone length is also an important consideration, as shorter bones are associated with longer upper lateral cartilage and a greater risk for collapse. 71,75 325e…”

“…69,70 However, there is no differences in the incidence of inverted-V deformities. 71 Preservation techniques maintain an intact dorsal roof by resecting the septum in conjunction with osteotomies. The push-down technique is indicated for humps smaller than 4 mm.…”

“…A recent study found that without reconstruction, surgeons rated 25% of patients as having a "surgical appearance" in the series; however, layperson scores and overall patient satisfaction exhibited more positive results. 71,74 An expert consensus panel has recommended routine midvault reconstruction in the form of primary closure, spreader flaps, or spreader grafts. Primary closure is limited to small resections, straight septums, absent airway symptoms, and strong upper lateral cartilages.…”

Discussion: Narrowing and Operated Appearance of the Middle Nasal Third after Hump Resection without Middle Vault Reconstruction

“…T he article entitled "Narrowing and Operated Appearance of the Middle Nasal Third after Hump Resection without Middle Vault Reconstruction" takes a look at a very important question that many rhinoplasty surgeons have commented on over the years. 1 In the study, the authors followed 22 patients who underwent composite hump reduction and 25 patients who underwent component hump reduction. The length of follow-up ranged from 12 to 96 months (median, 35 months) for the composite hump reduction group and 12 to 56 months (median, 22 months) for the component hump reduction group.…”