Abstract
The nasal midvault is an important consideration in rhinoplasty. This region is defined
by the attachment of the upper lateral cartilages (ULCs) to the nasal bones superiorly
and the cartilaginous septum medially. Inadequate management of the nasal midvault
can have negative functional and aesthetic ramifications. Indications for midvault
reconstruction in primary rhinoplasty include a narrow midvault, dorsal hump resection,
a deviated midvault, and an asymmetric midvault, with an additional relative indication
of zone 1 lateral wall insufficiency (LWI), defined as dynamic collapse of a weakened
lateral nasal wall at the level of the ULC. Numerous techniques for midvault reconstruction
have been described, dating back to Sheen's description of the spreader graft in the
1980s, which remains the gold standard for repair. Herein, the various indications
for midvault reconstruction are described, along with a discussion of the most commonly
used techniques for successful reconstruction.
Keywords
nasal obstruction - nasal midvault - rhinoplasty - midvault reconstruction
