Abstract
Management of the middle vault is paramount to achieving optimal aesthetic and functional
outcomes in rhinoplasty. The ideal treatment for middle vault complications, such
as internal nasal valve collapse, inverted-V deformity, and middle vault dorsal asymmetry,
is prevention. Risk factors for middle vault problems in rhinoplasty that may be identified
in preoperative consultation include short nasal bones, long and weak upper lateral
cartilages, thin skin, previous trauma or surgery, preoperative positive Cottle maneuver,
tension nose deformity, and anteriorly positioned inferior turbinates. When any of
these risk factors are identified, preventive measures should be pursued. These include
preservation of middle vault support structures, judicious resection in dorsal hump
reduction, use of conservative osteotomies, and reconstruction of the cartilaginous
middle vault with structural grafting. Spreader grafts have become the workhorse in
middle vault reconstruction. They are invaluable in restoring nasal dorsal aesthetic
lines, repairing or maintaining the internal nasal valve, and buttressing a corrected
crooked nose. Functional and aesthetic problems related to the middle nasal vault
are among the most common reasons for patients seeking revision rhinoplasty. Although
complications in rhinoplasty are inevitable, underlying their etiology and instituting
prophylactic treatment can significantly help reduce their occurrence.
Keywords
spreader grafts - middle vault - internal nasal valve repair - nasal valve collapse
- functional rhinoplasty
