Nasal Middle Vault Support: A New Technique

Abstract

A novel technique for maintaining internal nasal valve anatomic and physiologic integrity at the time of hump reduction is proposed. The procedure involves mobilizing the anterior edge of the upper lateral cartilage after submucosal dissection. Reduction of the anterior border of the septal cartilage and reconstruction of the middle vault of the nose is accomplished by placing the upper lateral cartilage medial border on the reduced edge of the septum using a vest-over technique. The technique was successfully used for 32 nonconsecutive patients over a 4-year period.

Rhinoplasty: Surface Aesthetics and Surgical Techniques

“…Currently, reconstitution of the dorsum can involve narrowing the defect with osteotomies, insertion of spreader grafts, or turning over of the upper lateral crura as spreader flaps. [10][11][12][13][14][15][16][17] The natural fusiform dorsal lines of the nasal dorsum are created anatomically by the spread of the cartilaginous vault and its overlying cap of bony dorsum, with the widest point at the keystone area ( Figure 2). In addition, the dorsal septum is 1 to 2 mm below the ULC in the keystone area.…”

Anatomical Variations of the Upper Lateral Cartilages and Their Implications in Rhinoplasty

“…Therefore, when performing a rhinoplasty, the surgeon must have thorough knowledge of the three nasal vaults and the dynamic interplay between them [1][2][3].…”

The accordion suture technique: A modified rhinoplasty spreader flap

“…In many previous studies, improvement in nasal air flow has been evaluated based on patient feedback. However, those studies did not analyze the feedback statistically (Seyhan, 1997;Acarturk and Gencel, 2003;Fayman and Potgieter, 2004;Byrd et al, 2007;Gruber et al, 2007;Neu, 2009;Manavbaş ı and Baş aran, 2013). In our present study, rhinomanometric analysis showed that the NAR significantly decreased in the postoperative period.…”

“…Numerous suture techniques have been described to eliminate drawbacks (Seyhan, 1997;Acarturk and Gencel, 2003;Fayman and Potgieter, 2004;Byrd et al, 2007;Gruber et al, 2007;Neu, 2009;Manavbaş ı and Baş aran, 2013). These techniques are based on folding the ULC with mattress sutures, since the ULC is approximately four times thinner than spreader grafts.…”

“…To obtain sufficient dorsal width, various modifications of the technique have been described. Thickness can be increased by rolling rather than folding the cartilage, and by use of special suture techniques (Seyhan, 1997;Acarturk and Gencel, 2003;Fayman and Potgieter, 2004;Byrd et al, 2007;Gruber et al, 2007;Neu, 2009;Manavbaş ı and Baş aran, 2013). The accordion suture technique features threefold bending of each ULC and formation of a nasal dorsal roof from seven cartilage layers, with a septum.…”