Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Component Hump Resection With Placement of Spreader Grafts
Disclosure Statement
Dr. Azizzadeh receives royalties from Wiley, Thieme, Elsevier & Springer. The other author has no financial or conflicts of interest to disclose. No funding was received for this article.
The Problem
Surgical reduction of the nasal dorsal hump is one of the most common maneuvers performed in rhinoplasty. A dorsal hump creates an aesthetically unpleasant appearance that frequently contributes to decreased self-confidence and negative social perception. This deformity can be intrinsic or acquired and is a common motivator for patients to seek rhinoplasty consultation. Excess dorsal hump can affect all ethnicities but is most frequently seen in White and Middle Eastern populations. Depending on individual features and patient aesthetic goals, the dorsal hump can be managed in a variety of ways. Regardless of the technique, reduction of the osseocartilaginous hump must be approached delicately because of the complex anatomy of the region and implications on aesthetics and breathing if done inappropriately. With proper execution, nasal hump reduction can restore balance and harmony to the face.
The Background
A nasal dorsal hump can be composed of bone, upper lateral cartilage (ULC) and/or septum. Involvement of these structures and to what degree largely impacts how the hump is approached surgically. Historically, composite hump resection was favored. This technique involves removal of the hump “en bloc,” starting with sharp incision of the caudal cartilaginous dorsum and completed by removal of the bony hump with an osteotome. Though effective, composite resection can lead to destabilization of the keystone area and loss of middle vault support. This paved the way for development of a less destructive method for hump reduction. Component resection addresses the bony and cartilaginous dorsum separately, allowing for a more controlled and stepwise approach to deprojection. The upper lateral cartilages and their mucosa are preserved, which maintains strength and width of the middle vault and decreases the risk of postoperative nasal valve collapse and inverted-V deformity. Another advantage of component reduction is that the ULCs can be folded over as a spreader flap or “auto-spreader” grafts in certain cases, reducing the overall need for excessive autologous cartilage from the septum in primary rhinoplasty. As a result of these advantages, component reduction is now favored in our practice over composite resection, with the goal to deliver natural results while preserving nasal anatomy and function.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here