Rhinoplasty and bony vault complications

Overview

The bony vault is the upper third of the nose, where hump removal and osteotomies are performed. Errors there leave visible irregularities, asymmetry, an open roof or collapse. The authors review the possible complications of bony vault surgery, explain what causes each, describe their appearance and set out corrective measures.

Sections of note

• Review article; no patient series, rates or outcomes appear in the abstract.
• Complications of bony vault surgery are described as avoidable with thorough preoperative assessment of the anatomy and meticulous technique.
• When a complication occurs, the authors state the irregularity must be identified and corrected.
• The article covers etiology, appearance and management of each complication.
• The abstract does not list the specific complications discussed.

What it means for a patient

• Problems with the bony bridge after rhinoplasty, such as bumps, steps or a too-wide upper nose, usually come from technique or planning and can be corrected.
• Careful examination before surgery is the first line of prevention.
• Expert review only; the abstract gives no figures on how often these problems occur.

Why this paper matters

The article is part of a Facial Plastic Surgery issue on rhinoplasty complications and gives a structured reference for recognizing bony vault problems. Comparative data on which techniques cause fewer complications are not presented.

Terms

• Bony vault: the upper third of the nose, formed by the paired nasal bones and the frontal processes of the maxilla.
• Osteotomy: a controlled cut through nasal bone to narrow or straighten the nose.
• Open roof deformity: a flat, wide upper bridge left when a hump is removed and the bones are not brought together.
• Rocker deformity: the upper end of a cut nasal bone tilting outward after an osteotomy carried too high.
• Dorsal irregularity: a visible or palpable bump or step on the bridge.