Clin Exp Otorhinolaryngol.  2018 Dec;11(4):275-280. 10.21053/ceo.2017.01816.

Triangular Resection of the Upper Lateral Cartilage for Middle Vault Deviation

• Ryu G
• Seo MY
• Lee KE
• Hong SD
• Chung SK
• Dhong HJ
• Kim HY

• KMID: 2439854
• DOI: http://doi.org/10.21053/ceo.2017.01816

Abstract

OBJECTIVES
Middle vault deviation has a significant effect on the aesthetic and functional aspects of the nose, and its management continues to be a challenge. Spreader graft and its modification techniques have been focused, but there has been scarce consideration for removing surplus portion and balancing the upper lateral cartilage (ULC). This study aimed to report the newly invented triangular-shaped resection technique ("triangular resection") of the ULC and to evaluate its efficacy for correcting middle vault deviation.
METHODS
A retrospective study included 17 consecutive patients who presented with middle vault deviation and underwent septorhinoplasty by using triangular resection at a tertiary academic hospital from February 2014 and March 2016. Their outcomes were evaluated pre- and postoperatively including medical photographs, acoustic rhinometry and subjective nasal obstruction using a 7-point Likert scale.
RESULTS
The immediate outcomes were evaluated around 1 month after surgery, and long-term outcomes were available in 12 patients; the mean follow-up period was 9.1 months. Nasal tip deviation angle was reduced from 5.66° to 2.37° immediately (P < 0.001). Middle vault deviation also improved from 169.50° to 177.24° (P < 0.001). Long-term results were 2.49° (P=0.015) for nasal tip deviation and 178.68° (P=0.002) for middle vault deviation. The aesthetic outcome involved a complete correction in eight patients (47.1%), a minimally visible deviation in seven patients (41.2%) and a remaining residual deviation in two patients (11.8%). Pre- and postoperative minimal cross-sectional areas (summation of the right and left sides) were 0.86 and 1.07, respectively (P=0.021). Fifteen patients answered about their nasal obstruction symptoms and the median symptom score had alleviated from 6.0 to 3.0 (P=0.004).
CONCLUSION
Triangular resection of the ULC is a simple and effective method for correcting middle vault deviation and balancing the ULCs without complications as internal nasal valve narrowing.

Keyword

Rhinoplasty; Nose; Acquired Nasal Deformities; Nasal Cartilages

MeSH Terms

Cartilage*
Follow-Up Studies
Humans
Methods
Nasal Cartilages
Nasal Obstruction
Nose
Nose Deformities, Acquired
Retrospective Studies
Rhinometry, Acoustic
Rhinoplasty
Transplants

Figure

• 

  Fig. 1. Surgical methods of triangular resection of the upper lateral cartilage. (A) Resect the triangular-shaped surplus cartilage. (B) The septum and the upper lateral cartilage repair with horizontal mattress sutures.

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  Fig. 2. Measurement of nasal tip deviation and middle vault deviation. (A) Nasal tip deviation was measured between the nasal tip (a) and midline from the nasion (b) to the philtrum (c). (B) Middle vault deviation was measured as the angle of the nasion (b), the most prominent point of convexity of the middle vault (d), and the nasal tip (e).

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  Fig. 3. Pre- and postoperative photographs of three patients. Preand postoperative photograph of patient 3 (A, B), patient 6 (C, D), and patient 15 (E, F).

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  Fig. 4. Objective and subjective measurements of nasal obstruction. (A) Pre- and postoperative changes of acoustic rhinometry with minimal cross-sectional area (MCA, cm2). (B) Likert scale of nasal obstruction.

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