ABSTRACT
Profile alignment, including nasal dorsal reduction, is one of the most common maneuvers
in aesthetic rhinoplasty. Techniques often include cartilaginous excision and bony
hump reduction with a chisel or a rasp. Cartilaginous nasal vault excision can result
in separation of the junction between the upper lateral cartilages and the dorsal
septum. This separation can cause an inferior-medial repositioning of the upper lateral
cartilages and overall weakening of middle vault infrastructure. Furthermore, surgical
interruption of this key region can also damage the internal nasal valve configuration
and function and create static and dynamic airway obstruction. This article outlines
the anatomy and function of the middle nasal vault and internal nasal valve. In addition,
it provides an overview of aesthetic complications of dorsal hump removal including
inverted-V deformity, saddle nose deformity, hourglass deformity, and their functional
consequences. Preoperative individual risk factors for middle-third deformities are
mentioned. Preventive and corrective surgical techniques including cartilage grafting
and reconstructive sutures are also detailed.
KEYWORDS
Rhinoplasty - middle vault - nasal dorsum - hump reduction - saddle nose
REFERENCES
Jonathan.sykes@ucdmc.ucdavis.edu
