We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Middle Vault Reconstruction

Jannis Constantinidis, MD, PhD
Arch Facial Plast Surg. 2007;9(2):139. doi:10.1001/archfaci.9.2.139-a.
Text Size: A A A
Published online


It is with great interest that I read the recent article by Gassner et al.1 The authors address a problem that to date has not been sufficiently addressed in functional rhinoplasty: structural pathologic characteristics of the transition of the upper lateral cartilage into the septum with resulting nasal valve obstruction.

Efforts at reconstructing this aspect of the middle vault, typically after resection of a dorsal hump, have included the placement of spreader grafts and dorsal onlay grafts. Other approaches include the Skoog technique2 and the push-down let-down approach used by Maurice H. Cottle, MD, and disciples.3 As Gassner et al1 point out, most methods of functional middle vault reconstruction to date aim at lateralizing the insertion of the cartilage into the septum. One established technique that allows for lateral rotation of the upper lateral cartilages and opening of the valve angle is the butterfly graft.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles