January 20, 2015
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Middle vault revision rhinoplasty explored at AACS

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NEW ORLEANS — The evaluation and management of refractory middle nasal vault asymmetry makes up 65% of all revision rhinoplasty, according to Erik J. Nuveen, MD, DMD, who spoke at the American Academy of Cosmetic Surgery Annual Scientific Meeting, here.

Ten percent of all primary rhinoplasty patients have airway compromise, according to Nuveen. Therefore, he recommended using schematic evaluations, treatment plans and operative reporting when managing this type of patient.

Nuveen said the three steps in patient evaluation are photography, listening to the chief concerns of the patient and the physical exam.

Possible cosmetic problems as a result of rhinoplasty include open vault, revealing deviation; excessive, inadequate or asymmetric hump removal; step deformities or inverted-V deformity; and bony and cartilaginous irregularities.

Depending on the situation, Nuveen recommended the use of butterfly conchal grafts, clocking suture techniques, spreader grafts, lateral crural turnover, septal/conchal and PDS plate (Mentor Worldwide) reinforcement for the management of these cases.

Nuveen said he has also invested in a generator for power loss, positive pressure for ventilation for respiratory embarrassment and a second cautery for failure of the first, and a PDS plate.

In addition to reviewing six case examples of refractory middle nasal vault asymmetry, Nuveen reviewed the anatomical region and provided treatment options and outcomes based upon the systemic method of treatment. – by Abigail Sutton

Reference:

Nuveen E J. Analysis and management of refractory middle nasal vault asymmetry. Presented at: American Academy of Cosmetic Surgery Annual Scientific Meeting. Jan. 13-17, 2015; New Orleans.

Disclosure: Nuveen has no relevant financial disclosures.