Reinserting the Hump in Primary Rhinoplasty: The Gain Is Three-fold

Overview

Removing a hump leaves the middle third of the nose unsupported, which can later cause a pinched look and blocked breathing. Instead of using separate cartilage grafts to rebuild it, the authors reuse the hump they just removed. The technique combines placing the modified hump between the upper lateral cartilages with bridging sutures between those cartilages.

Sections of note

• Retrospective review of primary aesthetic rhinoplasty patients undergoing hump resection.
• 62 patients enrolled: 46 with a straight nose and 16 with a deviated nose.
• 23 were operated through an open approach and 39 through a closed approach.
• Osteotomies were needed in 56 of the 62 patients.
• Mean follow-up 13 months, range 9 to 16 months.
• A satisfactory result was achieved in all but 3 patients, who had visible irregularities; 2 needed minimal rasping under local anesthesia and 1 declined further treatment.
• The technique is described as a modification of Skoog's original technique.
• The authors state the reinserted hump acts as both a spreader and an onlay graft, and the sutures increase the nasal valve angle while preventing displacement.

What it means for a patient

• Tissue removed from the bridge can be reused as the support graft, avoiding harvest from the septum, ear, or rib.
• Stated indications are a straight or mildly deviated nose, and a long thin-skinned nose with short nasal bones.
• The technique worked through both the open and the closed approach in this series.
• Limits: retrospective, 62 patients, single group with no comparison to spreader grafts or flaps, and mean follow-up of about 1 year, which is short for judging late irregularities.

Why this paper matters

Middle vault reconstruction after hump removal normally consumes donor cartilage, and this offers an alternative supply. Whether it holds contour as well as spreader grafts over many years is not tested here.

Terms

• Dorsal hump: The bump of bone and cartilage on the bridge of the nose.
• Middle vault: The middle third of the nose, between the bony bridge and the tip.
• Upper lateral cartilage: The paired cartilage forming the sidewall of the middle nose.
• Spreader graft: A cartilage strip placed alongside the septum to support the middle vault.
• Rasping: Filing down a small bony or cartilage irregularity.