The middle nasal vault is a sensitive region of the nose from both an esthetic and a functional perspective. It is critical for the rhinoplasty surgeon to properly evaluate and identify abnormalities of the middle vault when considering patients for primary or secondary surgery. This article addresses the surgical management of the cosmetic deformities and functional deficits of the middle vault and provides guidance for avoiding complications in this structurally critical region of the nose.
Key points
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The middle nasal vault is a critical region of the esthetics and function of the nose.
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Internal valve collapse is associated with abnormalities that arises in the middle vault.
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The thinnest nasal skin is over the middle third, and irregularities are often not well masked.
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Proper resuspension of the upper lateral cartilages during rhinoplasty will prevent postoperative cosmetic deformities and nasal obstruction.
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Dorsal hump reduction may unmask underlying middle vault abnormality and should be accompanied by appropriate grafting when indicated.
Introduction
Successful rhinoplasty is contingent on the appropriate evaluation of matching anatomic deformities to surgical strategies. The surgeon must understand the structurally sensitive regions of the nose and the implications of surgical alteration to both cosmesis and nasal function. The middle nasal vault is a critical anatomic region for the esthetics of the middle third of the nose as well as for maintaining nasal airflow. In patients evaluated for secondary rhinoplasty, middle third visual deformity and obstruction account for 2 of the 3 most common findings. In both primary and revision rhinoplasty, special consideration must be dedicated to addressing deformities and preserving supporting structures of the middle vault because this is an important point in the prevention of postoperative complications.
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