Management of the middle vault in endonasal rhinoplasty

Overview

The middle vault is the section of the nose between the bony bridge and the tip, and it carries both appearance and breathing consequences. Most published methods for preventing and repairing collapse there assume an open approach with an external incision. The authors state that their purpose is to describe endonasal options used by a single surgeon in a university hospital setting.

Sections of note

• Descriptive technique article. No patient numbers, study design, follow-up length, success rate or complication rate are reported.
• The setting is a university hospital based practice, with the techniques attributed to a single surgeon.
• The authors state that management rests on the anatomy and the functional integrity of this region.
• Diagnosis of middle vault insufficiency and methods to prevent and repair collapse are described as already widely reported.
• The gap the article addresses is that most existing descriptions assume an open rhinoplasty approach.
• The techniques described are alternatives for achieving the same repairs from inside the nostrils.

What it means for a patient

• Collapse of the middle third of the nose narrows the airway and can create a pinched look, so support there matters for breathing as well as appearance.
• The same problems can be treated through the nostrils, without an incision across the skin between them.
• The abstract gives no outcome figures, so there is no way to compare the endonasal route with the open route from this article.
• Single surgeon technique descriptions reflect one practice rather than tested general results.

Why this paper matters

The open approach dominates the published literature on middle vault support, which leaves surgeons using the endonasal route with fewer written references. What remains unanswered is whether the endonasal versions achieve the same durability of correction.

Terms

• Middle vault: the middle third of the nose, between the nasal bones and the tip.
• Endonasal approach: rhinoplasty done entirely through incisions inside the nostrils.
• Open rhinoplasty: rhinoplasty using a small external incision across the columella.
• Middle vault insufficiency: weakness in the middle third that narrows the airway or leaves a pinched shape.
• Internal nasal valve: the narrowest part of the airway, located in the middle vault.