Facial Plast Surg 2023; 39(06): 609-615
DOI: 10.1055/a-2148-2141
Original Article

Management of the Middle Vault

Asheema Pruthi
1   Eastern Virginia Medical School, Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Norfolk, Virginia
,
Eric Dobratz
1   Eastern Virginia Medical School, Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Norfolk, Virginia
,
William Dougherty
1   Eastern Virginia Medical School, Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Norfolk, Virginia
› Author Affiliations

Abstract

Early reductive rhinoplasty techniques focused on hump reduction and tip plasty with minimal focus on treating or preserving the integrity and width of the middle vault. With time, rhinoplasty surgeons noted the aesthetic and functional complications of the deformities that may occur in the middle vault with reduction techniques and developed methods to treat and also avoid these complications. Thus, the importance of protecting the integrity of the middle third of the nose has been increasingly emphasized over the years. Primary deformities of the middle vault that result in nasal obstruction require attention of the rhinoplasty surgeon, as well as preservation of support structures of the middle vault and internal nasal valve to minimize secondary deformities and functional compromise after rhinoplasty surgery.



Publication History

Accepted Manuscript online:
03 August 2023

Article published online:
14 September 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Fattahi T. Internal nasal valve: significance in nasal air flow. J Oral Maxillofac Surg 2008; 66 (09) 1921-1926
  • 2 Surowitz J, Lee MK, Most SP. Anterior septal reconstruction for treatment of severe caudal septal deviation: clinical severity and outcomes. Otolaryngol Head Neck Surg 2015; 153 (01) 27-33
  • 3 Baser B, Patel DK, Mishra A. The role of extracorporeal septoplasty in severely deviated nasal septum. Indian J Otolaryngol Head Neck Surg 2019; 71 (02) 271-277
  • 4 Toriumi DM. Management of the middle nasal vault in rhinoplasty. Operative Techniques in Plastic and Reconstructive Surgery 1995; 2 (01) 16-30
  • 5 Yoo DB, Jen A. Endonasal placement of spreader grafts: experience in 41 consecutive patients. Arch Facial Plast Surg 2012; 14 (05) 318-322
  • 6 Constantian MB, Clardy RB. The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast Reconstr Surg 1996; 98 (01) 38-54 , discussion 55–58
  • 7 Sheen JH, Sheen AP. Aesthetic Rhinoplasty. 2nd ed.. St. Louis: Mosby; 1998
  • 8 Grymer LF, Gregers-Petersen C, Baymler Pedersen H. Influence of lateral osteotomies in the dimensions of the nasal cavity. Laryngoscope 1999; 109 (06) 936-938
  • 9 Raggio BS, Asaria J. Filler Rhinoplasty. 2022. May 1. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2023
  • 10 Park SS. The flaring suture to augment the repair of the dysfunctional nasal valve. Plast Reconstr Surg 1998; 101 (04) 1120-1122
  • 11 Schlosser RJ, Park SS. Surgery for the dysfunctional nasal valve. Cadaveric analysis and clinical outcomes. Arch Facial Plast Surg 1999; 1 (02) 105-110
  • 12 Gubisch W. Extracorporeal septoplasty for the markedly deviated septum. Arch Facial Plast Surg 2005; 7 (04) 218-226
  • 13 King ED, Ashley FL. The correction of the internally and externally deviated nose. Plast Reconstr Surg (1946) 1952; 10 (02) 116-120
  • 14 Loyo M, Markey JD, Gerecci D. et al. Technical refinements and outcomes of the modified anterior septal transplant. JAMA Facial Plast Surg 2018; 20 (01) 31-36
  • 15 Teymoortash A, Fasunla JA, Sazgar AA. The value of spreader grafts in rhinoplasty: a critical review. Eur Arch Otorhinolaryngol 2012; 269 (05) 1411-1416
  • 16 Papel ID. Facial Plastic and Reconstructive Surgery. Otolaryngology—Head and Neck Surgery 1992; 106 (01) 4
  • 17 Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 1984; 73 (02) 230-239
  • 18 Tasman AJ. Rhinoplasty - indications and techniques. GMS Curr Top Otorhinolaryngol Head Neck Surg 2007; 6: Doc09
  • 19 Gruber RP, Perkins SW. Humpectomy and spreader flaps. Clin Plast Surg 2010; 37 (02) 285-291
  • 20 Oneal RM, Berkowitz RL. Upper lateral cartilage spreader flaps in rhinoplasty. Aesthet Surg J 1998; 18 (05) 370-371
  • 21 Clark JM, Cook TA. The ‘butterfly’ graft in functional secondary rhinoplasty. Laryngoscope 2002; 112 (11) 1917-1925
  • 22 Genther DJ, Wang TD. Modification of the butterfly graft. JAMA Facial Plast Surg 2018; 20 (06) 509-510
  • 23 Skoog T. A method of hump reduction in rhinoplasty. A technique for preservation of the nasal roof. Arch Otolaryngol 1966; 83 (03) 283-287
  • 24 Hall JA, Peters MD, Hilger PA. Modification of the Skoog dorsal reduction for preservation of the middle nasal vault. Arch Facial Plast Surg 2004; 6 (02) 105-110