Vertical Sectioning of the Cartilaginous Vault for Rhinoplasty: Technique and Assessment.

[OBJECTIVES] To describe and assess the vertical sectioning technique for mid vault dissection in patients undergoing primary and secondary rhinoplasty.

[METHODS] A retrospective review of 208 patients undergoing primary or revision rhinoplasty utilizing the vertical sectioning technique. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to patients pre- and post-operatively. A detailed description of the technique is presented.

[RESULTS] Mean follow up was 8.59 ± 7.30 months. Spreader grafts were used in 185 patients (89%), upper lateral cartilage autospreader flaps were utilized in 16 patients (7.7%), and both spreader grafts and autospreader flaps were used in 7 patients (3.4%). Ten primary rhinoplasty patients (4.8%) and 3 revision rhinoplasty patients (4.5%) complained of functional nasal obstruction post-operatively. At time of last follow-up, there was a significant improvement in mean NOSE scores for patients receiving spreader grafts (71.2 ± 21.4-21.5 ± 2.8,  < .001), autospreader flaps (69.2 ± 25.9-17.2 ± 21.5,  < .001), and both (57.9 ± 35.0-26.1 ± 20.2,  = .03).

[CONCLUSION] The vertical sectioning technique respects the anatomic, functional, and esthetic relationship of the middle vault, while maximizing cartilage preservation.