Options for Middle Vault and Dorsum Restoration after Hump Removal in Primary Rhinoplasty

Overview

Removing a dorsal hump opens the middle third of the nose and can leave it narrow, irregular, or prone to collapse when breathing in. This paper reviews the two families of repair, notes the drawbacks of each, describes modifications, and presents a decision algorithm. It is a review and technique article without a reported patient series.

Sections of note

• Restoration of the middle vault is described as necessary in most patients, with the possible exception of small humps.
• Category one, spreader grafts, requires donor cartilage taken from elsewhere.
• Category two, spreader flaps, uses the excess height of the inner portion of the upper lateral cartilages, available in patients with a cartilaginous hump.
• Both methods place tissue along each side of the dorsal septum.
• Stated goals are natural contours and avoiding functional impairment from valve collapse.
• The authors note that the volume of publications on this topic indicates both principles have shortcomings, and they present modifications to each.
• The main contribution is an algorithm to match technique to the individual patient.

What it means for a patient

• Removing a hump is only half the operation; the middle of the nose usually has to be rebuilt.
• A spreader flap uses tissue already present, while a spreader graft requires harvesting cartilage from the septum, ear, or rib.
• No outcome numbers, complication rates, or follow-up are reported in this abstract.
• The choice between the two depends on individual anatomy, particularly whether the hump is cartilaginous.

Why this paper matters

Middle vault collapse after hump reduction is a classic and preventable cause of both a pinched look and blocked breathing. An explicit algorithm helps surgeons decide rather than default to one habit. The paper does not report comparative data showing which technique performs better in which anatomy.

Terms

• Dorsal hump: The bump on the bridge of the nose, made of bone and cartilage.
• Middle vault: The middle third of the nose, between the bony bridge and the tip.
• Spreader graft: A strip of cartilage placed alongside the septum to widen and support that section.
• Spreader flap: The upper lateral cartilage folded inward and used in place of a graft.
• Upper lateral cartilage: The paired cartilage forming the sidewall of the middle nose.
• Internal nasal valve: The narrowest part of the airway.