Combined Functional and Preservation Rhinoplasty

Overview

The article compares dorsal preservation with conventional hump takedown from a breathing standpoint. In preservation surgery the nasal vault is treated as one block rather than opened, so the internal nasal valve angle is not disrupted and the middle of the nose does not need rebuilding. The review covers the technique options and the current state of the functional evidence.

Sections of note

• Review article; the abstract reports no patient numbers, no rates and no follow up of its own.
• The authors state dorsal preservation has aesthetic advantages over conventional hump takedown rhinoplasty.
• The nasal vault is treated en bloc, so the internal nasal valve angle is not disrupted.
• No midvault reconstruction is needed, which conventional hump removal typically requires.
• Two techniques exist for handling the bony vault: the let down and the push down.
• A variety of techniques exist for handling the septum in preservation surgery.
• Available patient reported outcomes suggest positive results in nasal breathing.
• The authors state more robust data are needed to clarify functional results and compare breathing outcomes.

What it means for a patient

• Conventional hump removal opens the roof of the nose and usually requires spreader grafts to keep the airway from narrowing; preservation avoids that step.
• Current breathing evidence for preservation is described by the authors themselves as insufficient.
• No numbers appear here, so this cannot tell a patient how much breathing differs between the two approaches.

Why this paper matters

The functional argument is the main claim made for dorsal preservation beyond appearance. This review states that claim and then states that the data supporting it are thin. Direct comparison of breathing outcomes between preservation and conventional reduction remains the open question.

Terms

• Dorsal preservation: lowering the natural nasal bridge instead of cutting the hump off.
• Internal nasal valve: the narrowest part of the nasal airway, where the septum meets the upper cartilages.
• Nasal vault: the bone and cartilage roof of the nose.
• Midvault reconstruction: rebuilding the middle third of the nose after the roof has been opened.
• Push down and let down: two ways of lowering the bony framework, differing in how much bone is removed.