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Surgical Technique
January 2002

Middle-Vault Narrowing in the Wide Nasal DorsumThe "Reverse Spreader" Technique

Author Affiliations

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.

 

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.

Arch Facial Plast Surg. 2002;4(1):52-55. doi:
Abstract

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.

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