Midvault Reconstruction in Primary Rhinoplasty

Overview

The midvault is the section where the upper lateral cartilages attach to the nasal bones above and to the septum in the middle. The authors state that handling it inadequately has both functional and appearance consequences. This article lists the situations requiring reconstruction and reviews the techniques most used for it.

Sections of note

• The midvault is defined by the attachment of the upper lateral cartilages to the nasal bones above and the cartilaginous septum medially.
• Indications for reconstruction in primary rhinoplasty: a narrow midvault, dorsal hump resection, a deviated midvault, and an asymmetric midvault.
• A relative indication is zone 1 lateral wall insufficiency, defined as dynamic collapse of a weakened lateral nasal wall at the level of the upper lateral cartilage.
• Numerous techniques have been described, dating to Sheen's description of the spreader graft in the 1980s.
• The spreader graft is stated to remain the gold standard for repair.
• The abstract reports no patient numbers, outcome rates, or follow-up.

What it means for a patient

• Removing a hump is itself a reason to rebuild the midvault, not an optional add-on.
• Dynamic collapse means the side wall falls inward when you breathe in, which is checked by watching the nose during inspiration rather than at rest.
• A narrow, crooked, or uneven middle third are separate reasons for the same reconstruction.
• This is a review without measured outcomes, so it does not report how the techniques compare.

Why this paper matters

Midvault collapse after hump reduction is a well recognized and preventable cause of both a pinched appearance and blocked breathing. Setting out explicit indications makes the step a decision rather than a habit. The review does not rank the alternatives to the spreader graft.

Terms

• Midvault: 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 that section.
• Lateral wall insufficiency: Weakness of the side wall allowing it to collapse inward on breathing in.
• Dorsal hump resection: Removal of the bump on the bridge of the nose.