From the Divisions of Facial Plastic and Reconstructive Surgery, Departments
of Otolaryngology–Head and Neck Surgery, St Louis University Health
Sciences Center, St Louis, Mo (Drs Prendiville and Kokoska), Beth Israel Medical
Center, New York, NY (Dr Zimbler), and University of Illinois at Chicago (Dr
Thomas). Dr Prendiville is now with the Fort Myers Centre, Facial Plastic& Laser Surgery, Ft Myers, Fla.
The middle vault is a transition zone between the nasal tip and nasal
bones and plays an important role in profile, tip projection, tip rotation,
and tip support. This report presents an alternative to conventional techniques
specific to the middle nasal vault for a patient population with particular
nasal features. A narrow middle vault with internal nasal valve collapse is
functionally and aesthetically addressed by the insertion of spreader grafts.
However, the inverse of this situation is sometimes encountered. A patient
with a broad middle vault and without internal nasal valve collapse will benefit
from reduction of the horizontal width of the cartilaginous dorsum, which
is in effect the reverse of spreader grafts. This effect is achieved by excising
a vertical wedge-shaped strip of cartilage that follows the length of the
upper lateral cartilage at the junction of the upper lateral cartilage and
the dorsal nasal septum.
Prendiville S, Zimbler MS, Kokoska MS, Thomas JR. Middle-Vault Narrowing in the Wide Nasal DorsumThe "Reverse Spreader" Technique. Arch Facial Plast Surg. 2002;4(1):52-55. doi: