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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.
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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.

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