Spare Roof Technique: A Middle Third New Technique

Ferreira, Miguel Gonçalves; Monteiro, Daniel; Reis, Cláudia; Sousa, Cecília Almeida e

doi:10.1055/s-0035-1570503

Cited by 75 publications

(19 citation statements)

References 9 publications

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“…The dorsal modulation techniques allows one to reshape this S-shaped bone and the underlying cartilaginous midvault convexity defect. 4 Also, we have observed that, in the vast majority of patients, the nasal hump had no ethmoid bone underneath it; therefore, there should be no need to address it. Unnecessary removal of the posterior ethmoidal plate may lead to sinking of the overlying the nasal bones when lowering the nasal dorsum, creating a visible step.…”

Section: Discussionmentioning

confidence: 91%

The Caucasian Hump: Radiologic Study of the Osteocartilaginous Vault versus Surface Anatomy. Clinical Implications in Structured and Preservation Rhinoplasty

Dias

Cardoso

Santos

et al. 2021

Plastic &Amp; Reconstructive Surgery

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Achieving pleasant aesthetic lines along the nasal dorsum requires a thorough knowledge of the anatomy of the osteocartilaginous vault and keystone area. 1,2 Despite being a very common procedure in rhinoplasty, a "simple" nasal hump reduction may lead to aesthetic problems such as overresection or underresection; inverted-V deformity; dorsal irregularities; and, in some cases, functional nasal complaints. 3 A growing number of dorsum preservation rhinoplasty techniques have been proposed recently. [4][5][6] These aim to preserve the keystone area and the continuity of the cartilaginous middle vault to prevent the need for its reconstruction (as opposed to structured rhinoplasty techniques). There is consensus that nasal anatomy should guide surgical decision-making, and several studies have described the anatomy of the osteocartilaginous vault of the nose. However, few studies have actually investigated how different

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Section: Discussionmentioning

confidence: 91%

The Caucasian Hump: Radiologic Study of the Osteocartilaginous Vault versus Surface Anatomy. Clinical Implications in Structured and Preservation Rhinoplasty

Dias

Cardoso

Santos

et al. 2021

Plastic &Amp; Reconstructive Surgery

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“…No PPE excision was noted. Additionally, in a cadaveric study, an intact cartilage vault was found after bony cap removal 9 …”

Section: Discussionmentioning

confidence: 95%

“…Additionally, in a cadaveric study, an intact cartilage vault was found after bony cap removal. 9 To investigate the relationship between the PPE and the starting point of the nasal hump, the BC distance was assessed. In our study, the BC distance measured 0 mm in 39 of 100 patients (39%), meaning that there was no cartilaginous septum below the starting point of the nasal hump.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 The basis of this technique was first introduced by Lothrop in 1914. 5 Afterward, many techniques were defined by several authors: the ''push down'' 6 and ''let down'' 7 techniques, the ''preservation rhinoplasty'', 8 the ''spare roof technique'', 9 the ''dorsal split preservation technique'' 10 and the ''dorsal roof technique''. 11 The main idea of these techniques is based on preserving keystone integrity and dorsal esthetic lines.…”

mentioning

confidence: 99%

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Preservation Rhinoplasty: Assessment of Anatomical Safe Boundaries on Computed Tomography

Demirel

Atesci

2021

Journal of Craniofacial Surgery

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Background: Nasal dorsum reconstruction is a crucial step of the rhinoplasty. For avoiding complications, techniques that preserve natural dorsal anatomy becomes popular recently. In preservation techniques, ethmoidal bone surgery may take part in the vast majority of defined techniques. Therefore, detailed anatomical knowledge is essential to avoid severe complications, especially cerebrospinal fluid leakage. Based on these, this study aimed to investigate anatomical safe boundaries of preservation techniques based on the measurements on computed tomography. Methods: A total of 100 patients who underwent paranasal computed tomography were enrolled in this retrospective study. Five groups were selected based on the age distribution. The distance of the dorsal osteotomy line to cranial base, amount of cartilaginous/bony septum overlaps under nasal bones, cartilaginous/bony septum length anterior and posterior to the nasal hump starting point, and anteroposterior distance of perpendicular plate was measured. Results: The mean distance between the starting point of the nasal hump and the cribriform plate was 29.5 mm. The amount of bony overlap above the cartilaginous septum was 10.9 mm in females and 10.5 mm in males. The length of septal cartilage posterior to nasal hump was 0 mm in 39 of 100 patients (39%) and the mean value was 2.38 mm in all populations. The mean distance from the starting point of the perpendicular plate to the cribriform plate was 28.17 mm. Conclusions: Perpendicular plate may take part in the constitution of the nasal hump. Therefore, delicate surgery with appropriate tools needed for avoiding the risk of skull base injury.

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“…he spare roof technique is a middle-third preservation technique, described in 2016 by Ferreira et al, that allows the surgeon to isolate the entire cartilaginous roof of the middle third without splitting the upper lateral cartilages among them. 1 The spare roof technique includes ostectomy of the bony cap. [1][2][3][4] However, taking into account the clinical and surgical experience acquired over the past years, the authors consider that for patients with V-shaped nasal bones, it would be possible to dehump the nose while preserving the dorsal keystone area.…”

mentioning

confidence: 99%

Ferreira-Ishida Technique: Spare Roof Technique B. Step-by-Step Guide to Preserving the Bony Cap While Dehumping

Ferreira

Ishida

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Summary: For V-shaped nasal bones, the authors consider that ostectomy of the dorsal keystone area can be avoided, and this has led to the development of a new preservation technique: the spare roof technique B (or Ferreira-Ishida technique), where the bony cap is preserved. It includes six main steps, as follows. Step 1, draw on the surface of the skin the desired dorsal brow-tip aesthetic lines, the pyriform aperture, the rhinion, and the amount of triangular bone that has to be taken out to allow pushing-down the bony cap, and the transversal line in the beginning of the nasal hump. Step 2, release the upper lateral cartilages from the dorsal septum (“high septal strip”). Step 3, take out the amount of dorsal septum necessary to dehump. Step 4, perform the paramedian high parallel osteotomies exactly below the marked brow-tip dorsal aesthetic lines. Then, perform the second group of lower osteotomies, until the E-point, to achieve a triangular shape of bone in each side of the bony cap. Perform the ostectomy of the mentioned triangular areas. Release the lateral keystone area. Perform partial ultrasonic ostectomy endonasally, below the nasal bones, to promote the weakening of the transverse fracture line, in the sagittal plane just above the E-point. Push-down gently the rectangular bony cap with a Luc nasal forceps (19 cm) in a greenstick fashion. Perform lateral traditional osteotomies from high to low to high to narrow the bony bridge as much as is needed. Step 5, perform a regular L-shape Cottle septoplasty (if necessary). Step 6, suture the cartilaginous middle vault (upper lateral cartilages) to the dorsal aspect of the remaining septum.

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Spare Roof Technique: A Middle Third New Technique

Cited by 75 publications

References 9 publications

The Caucasian Hump: Radiologic Study of the Osteocartilaginous Vault versus Surface Anatomy. Clinical Implications in Structured and Preservation Rhinoplasty

The Caucasian Hump: Radiologic Study of the Osteocartilaginous Vault versus Surface Anatomy. Clinical Implications in Structured and Preservation Rhinoplasty

Preservation Rhinoplasty: Assessment of Anatomical Safe Boundaries on Computed Tomography

Ferreira-Ishida Technique: Spare Roof Technique B. Step-by-Step Guide to Preserving the Bony Cap While Dehumping

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