Using the Autospreaders as a Cutting Guide for Component Hump Reduction in Rhinoplasty

Overview

Dorsal preservation techniques have been popularized as a way to address a hump without disrupting the middle of the nose or cutting the bridge away. The authors state the drawback of those techniques is a higher rate of hump recurrence, up to 15 percent. They present an alternative using the upper lateral cartilages as a turn in flap and as a guide for the cut during classic hump takedown.

Sections of note

• Technique article; the abstract reports no patient numbers, no outcomes, no complication rates and no follow up.
• Dorsal preservation is stated to carry hump recurrence rates of up to 15 percent.
• The upper lateral cartilages are used as a turn in flap and as a cutting guide.
• The cutting guide is stated to provide the correct dorsal angulation.
• It is also stated to dictate the amount of resection needed.
• The claimed results are pleasing dorsal lines, avoidance of dorsal irregularities and decreased risk of hump recurrence.

What it means for a patient

• This is conventional hump removal, not preservation, with the cartilage used to control how much is cut.
• Folding the same cartilage inward afterward keeps the airway from narrowing, avoiding a separate graft.
• The 15 percent recurrence figure cited for preservation is higher than the pooled figures reported elsewhere.
• No results are reported for this technique, so its claimed advantages are untested.

Why this paper matters

Hump recurrence is the main criticism of preservation rhinoplasty, and this article proposes returning to conventional removal with better control over the cut. It positions technique against philosophy. Whether it reduces recurrence or irregularity has not been measured.

Terms

• Autospreader: the patient's own upper cartilages folded inward to keep the airway open.
• Turn in flap: cartilage folded inward rather than removed.
• Component hump reduction: taking the hump down in separate bone and cartilage steps.
• Dorsal preservation: lowering the natural bridge instead of cutting the hump off.
• Hump recurrence: the bump becoming visible again after surgery.
• Midvault: the middle third of the nose between the bony bridge and the tip.