Rebuilding the Middle Vault in Rhinoplasty: A New Classification of Spreader Flaps/Grafts

Overview

After a hump is removed the middle third of the nose must be rebuilt, or it can narrow, look pinched and obstruct breathing. Two families of technique do this: cartilage strips added alongside the septum, and folded flaps made from the patient's own upper lateral cartilage. This article organizes the many variants into a single naming scheme.

Sections of note

• Rebuilding the middle vault is described as a main step following hump removal in reduction rhinoplasty.
• Spreader grafts are stated to have long been the main tool available.
• Spreader flaps became popular within the last two decades.
• The author notes many different options exist according to each surgeon's experience and preference.
• Spreader grafts are classified into four types: traditional, modified, splinting, and reconstructive.
• Spreader flaps are organized by their relationship to the septum and to the spreader grafts.
• The abstract reports no patient numbers, outcomes, complication rates, or follow-up.

What it means for a patient

• The terms different surgeons use for middle vault reconstruction often describe variations of the same two ideas.
• A graft requires harvested cartilage; a flap reuses cartilage already present in the nose.
• This is a classification and technique article without measured results, so it does not show which variant performs best.

Why this paper matters

Inconsistent naming has made it hard to compare middle vault techniques across published series. A shared classification is a prerequisite for that comparison. The paper does not supply the outcome data that would rank the four graft types against each other.

Terms

• Middle vault: The middle third of the nose, between the bony bridge and the tip.
• Spreader graft: A cartilage strip placed alongside the septum to support that section.
• Spreader flap: The upper lateral cartilage folded inward and used instead of a graft.
• Septum: The central wall of cartilage and bone dividing the nose.
• Reduction rhinoplasty: An operation based mainly on removing tissue to make the nose smaller.