Split hump technique for reduction of the overprojected nasal dorsum: a statistical analysis on subjective body image in relation to nasal appearance and nasal patency in 97 patients undergoing aesthetic rhinoplasty

Overview

Removing a hump in one piece takes the top of the upper lateral cartilages with it, and surgeons then add spreader grafts to stop the middle vault falling inward. The split hump technique instead separates the cartilage sides from the bony hump, preserves them and repositions them. The authors tested patient-rated appearance and breathing before and after.

Sections of note

• Prospective study of 97 aesthetic rhinoplasty patients.
• Assessment by a short questionnaire: 5-point Likert items for breathing and for body image related to the nose, plus visual analog scales.
• Sum functional scores fell from 9.154 to 6.351; aesthetic question scores fell from 13.897 to 6.825 (lower is better; P < .001 for both).
• Mean aesthetic visual analog score improved in all patients, from 3.346 to 7.782 (P < .001); mean improvement 4.48 (SD 1.93), normally distributed.
• Technique: the transverse segments of the upper lateral cartilages are saved and repositioned instead of resected with the bone-cartilage hump.
• Modifications allow deprojection while keeping keystone strength and adding dorsal width.
• The abstract does not state follow-up length or complication counts.

What it means for a patient

• Hump removal can be done without cutting away the cartilage that keeps the middle of the nose open, reducing the need for added grafts.
• Every patient in this series rated the appearance better afterward, and breathing scores improved as a group.
• Patient questionnaires without a comparison group or objective airway measurement; single center.

Why this paper matters

The split hump technique is one of several cartilage-preserving hump methods that led toward dorsal preservation rhinoplasty. This is its largest outcome series to that date. Head-to-head comparison with en bloc resection plus spreader grafts is not provided.

Terms

• Overprojected dorsum: a bridge that stands too far forward, usually a hump.
• En bloc humpectomy: removing the bone and cartilage hump as a single piece.
• Upper lateral cartilages: the paired cartilages forming the sides of the middle third of the nose.
• Inverted-V deformity: a visible V-shaped shadow where the nasal bones end, from the upper lateral cartilages falling inward.
• Keystone area: the junction of nasal bones, upper lateral cartilages and septum at the middle of the bridge.
• Likert scale: a rating scale with fixed points, here 5.