Dorsal Hump Deformity in Compromised Internal Valve

The Background

The dorsal hump is an ethnic feature in the Mediterranean White and Middle Eastern populations. The reduction of the dorsal hump has become a crucial rhinoplasty step in this group of patients. Depending on the degree of reduction, the surgery includes the upper lateral cartilage in most of the cases and an osteocartilaginous resection of the hump and septal region. However, the reduction of this feature is associated with dismantling the keystone of the nasal pyramidal structure, which improves the profile view but worsens the frontal view paradoxically. Without reconstruction of this defect, a patient has serious aesthetic and functional deformities. The major complication associated with the non-reconstruction of hump resection is open roof deformity. One of the general solutions is to minimize the gap between the lateral components with a lateral osteotomy. There are many methods to perform this maneuver, but the outcome is unpredictable in terms of movement as it results in the loss of natural curvature and turns the hump into a crest. Many surgeons prefer the spreader graft to overcome this shortcoming, which is very successful in preventing an open roof deformity. However, there are a great number of patients who are not satisfied with the results. The authors used a modified spreader graft also known as the docile graft to overcome the disadvantages of other methods.

The Patient

A 24-year-old male patient with a history of trauma and nasal obstruction on functional inspiration was presented. The patient was also seeking aesthetic improvements. Clinical examination showed that the patient had a septal deviation toward the right side and an internal nasal valve collapse on the left side. The lateral view showed an acute nasolabial angle with an excessive hump. The treatment was focused on tip rotation and internal nasal valve reconstruction with hump reduction ( Table 24.1 , Figs. 24.1–24.4 ).

The hump reduction and nasal widening are a paradox in rhinoplasty; if one tries to reduce the nasal hump without the internal nasal valve reconstruction, an obstruction is inevitable, but using a spreader graft as a solution results in excessive nasal widening. The aim of this method is internal nasal reinforcement without increasing nasal width.