Dorsal Roof Technique for Dorsum Preservation in Rhinoplasty

Overview

Removing a hump destroys the internal valve and keystone area, which then have to be rebuilt with flaps or grafts. This technique instead reshapes the existing bridge roof, addressing a wide bridge, a wide nasal base and a hump without removing tissue.

Sections of note

• 52 patients, 35 female and 17 male, underwent septorhinoplasty with the dorsal roof technique; data evaluated retrospectively.
• All patients were photographed in standard views during follow-up, and photographs were examined by two independent plastic surgeons.
• Pyramidal angles were measured with a protractor before surgery and at 1 year.
• A rhinoplasty outcomes evaluation questionnaire was administered at the 1-year visit; functional improvement was assessed by self-reported nasal patency.
• 44 of the 52 patients completed the 1-year follow-up and questionnaire.
• No irregularity or residual hump was detected during follow-up.
• Significant narrowing was achieved, P below 0.001; high patient satisfaction was reported and no functional or aesthetic complications were encountered.

What it means for a patient

• The bridge is reshaped rather than shaved down, so the natural surface and the internal valve are kept.
• Both height and width were addressed in the same maneuver.
• Limits: 52 treated but 44 assessed, one surgeon, retrospective, no comparison group, and 1 year of follow-up.
• Breathing improvement was self-reported rather than measured, and satisfaction is described as high without a numeric value.

Why this paper matters

Dorsal preservation avoids the middle vault reconstruction that hump removal makes necessary, and the wide bridge has been a limitation of preservation techniques. Addressing width within the same approach extends its range. Without a comparison arm or longer follow-up, hump relapse risk is unaddressed here.

Terms

• Dorsum: The bridge of the nose.
• Dorsal preservation: Lowering the bridge without shaving off its surface.
• Keystone: The junction where the nasal bones meet the cartilage of the middle nose.
• Internal nasal valve: The narrowest part of the nasal airway.
• Pyramidal angle: The angle describing how wide the bony pyramid of the nose is.