Management of the Middle Vault in Endonasal Rhinoplasty

Abstract

The management of the middle vault has become a crucial consideration in esthetic and functional rhinoplasty. Central to this management is an acknowledgment of the importance of the anatomic features and functional integrity of this nasal region. The diagnosis of middle vault insufficiency and techniques to prevent and repair such collapse have been widely reported. Many of these descriptions are based on the management of the middle vault using an open rhinoplasty approach. The purpose of this article is to describe various options for the management of the middle vault using an endonasal approach that have been used by a single surgeon in a university hospital–based setting.

Keywords

nasal valve - rhinoplasty - endonasal - spreader grafts - autospreader flaps

• References

• 1 Cottle MH. The structure and function of the nasal vestibule. AMA Arch Otolaryngol 1955; 62 (2) 173-181
• 2 Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 1984; 73 (2) 230-239
• 3 Faris C, Koury E, Kothari P, Frosh A. Functional rhinoplasty with batten and spreader grafts for correction of internal nasal valve incompetence. Rhinology 2006; 44 (2) 114-117
• 4 Kern EB. Surgical approaches to abnormalities of the nasal valve. Rhinology 1978; 16 (3) 165-189
• 5 Rohrich RJ, Hollier LH. Use of spreader grafts in the external approach to rhinoplasty. Clin Plast Surg 1996; 23 (2) 255-262
• 6 Haight JS, Cole P. The site and function of the nasal valve. Laryngoscope 1983; 93 (1) 49-55
• 7 Boccieri A, Macro C, Pascali M. The use of spreader grafts in primary rhinoplasty. Ann Plast Surg 2005; 55 (2) 127-131
• 8 Byrd HS, Meade RA, Gonyon Jr DL. Using the autospreader flap in primary rhinoplasty. Plast Reconstr Surg 2007; 119 (6) 1897-1902
• 9 Ozmen S, Ayhan S, Findikcioglu K, Kandal S, Atabay K. Upper lateral cartilage fold-in flap: a combined spreader and/or splay graft effect without cartilage grafts. Ann Plast Surg 2008; 61 (5) 527-532
• 10 Pepper JP, Baker SR. The autospreader flap in reduction rhinoplasty. Arch Facial Plast Surg 2011; 13 (3) 172
• 11 Stacey DH, Cook TA, Marcus BC. Correction of internal nasal valve stenosis: a single surgeon comparison of butterfly versus traditional spreader grafts. Ann Plast Surg 2009; 63 (3) 280-284
• 12 Pontius AT, Williams III EF. Endonasal placement of spreader grafts in rhinoplasty. Ear Nose Throat J 2005; 84 (3) 135-136
• 13 Yoo DB, Jen A. Endonasal placement of spreader grafts: experience in 41 consecutive patients. Arch Facial Plast Surg 2012; 14 (5) 318-322
• 14 Larrabee W, Cupp C. Advanced nasal anatomy. Fac Plas Surg Clin 1994; 2 (4) 393-416
• 15 Setabutr D, Sohrabi S, Kalaria S, Gordon K, Fedok FG. The relationship of external and internal sidewall dimensions in the adult Caucasian nose. Laryngoscope 2013; 123 (4) 875-878
• 16 Boccieri A. Mini spreader grafts: a new technique associated with reshaping of the nasal tip. Plast Reconstr Surg 2005; 116 (5) 1525-1534
• 17 Camirand A, Doucet J, Harris J. Nose surgery: how to prevent a middle vault collapse—a review of 50 patients 3 to 21 years after surgery. Plast Reconstr Surg 2004; 114 (2) 527-534
• 18 Manavbasi I, Agaoglu G. Endonasal placement of spreader grafts. Plast Reconstr Surg 2007; 119 (6) 1961-1962
• 19 Tellioglu AT. Autospreader flap. Plast Reconstr Surg 2008; 122 (1) 313
• 20 Yoo S, Most SP. Nasal airway preservation using the autospreader technique: analysis of outcomes using a disease-specific quality-of-life instrument. Arch Facial Plast Surg 2011; 13 (4) 231-233