The nose is a delicate organ and made up of a complex structure of bones, cartilages, and tissues. If there is any imbalance in the structure of the nose it can lead to complications. Sometimes these complications arise because of after effects of previous surgeries or previous surgeries like Rhinoplasty and Septoplasty gone wrong or because of trauma.
One common such problem is the middle vault collapse. The middle vault collapse on the nose appears as a dip in the nose from the side profile. The nose appears as if the upper third portion has collapsed. The structures dip on the nose can be caused because of weakness or disharmony between the nasal bones and upper lateral cartilage. It can be because of injuries or sometimes people are just born with weak cartilages. Weak cartilages can cause nasal obstructions and difficulties in breathing. People who have had hump reduction also run in the issue of ‘v’ shaped deformity. Internal nasal valve collapse can happen even years after you have had your first Rhinoplasty however the signs start appearing gradually for you to notice. You must discuss the possibility of the collapse of the middle third of the nose post Rhinoplasty and steps that can be taken to avoid the same if possible.
The best advice for treatment of middle vault collapse of the nose can be given by an expert Rhinoplasty surgeon. The middle vault is the middle third of the nose and comprises of two upper lateral cartilages and dorsal part of the nasal septum. The skin over the vault is thin.
The first step to the diagnosis is to understand the patient’s pathology and the amount of nasal obstruction. Therefore, when you go to visit the surgeon for the first consultation, make sure that you carry all your medical reports and prescriptions of medicines if you are taking any. The surgeon will physically examine you to gauge the skin quality (helps in determining healing times and the final look), observe the nose at rest and when active, to understand the nasal framework to gather information about any other irregularities, the stability and elasticity of the framework.
Middle vault collapse can be corrected using both surgical and non-surgical techniques. The surgeon on examination will be able to advise you the type of approach needed for you. Computer imaging will let you see what changes will come to your nose. Non-surgical techniques for repair of the nose include the use of temporary and permanent fillers to fill up the ‘v’ shape.
Since middle vault collapse correction is a complex Rhinoplasty surgery, various techniques can be used to make the corrections. These include
Spreader graft Technique complex Rhinoplasty
The spreader graft is one of the most popular corrective techniques used for bringing the middle vault back in shape. The grafts are taken from the septum and can be placed both unilaterally and bi laterally between the bone and the cartilage to give it a proper shape. However the limitations include scarring, irregularities and deviation of the septum.
Nasal valve surgery
In cases then there is an over resection of cartilage and mucosa, it is necessary to use other techniques such as strut grafts to widen the nasal valve.
Also, dorsal augmentation and dorsal deviation corrections can be used to give a proper shape to the nose and ensure that the deformity does not occur again.
Complex Rhinoplasties like the middle vault collapse surgeries require time and attention by the surgeon and therefore it should not be a hurried up process and careful and due deliberation should be given to the outcome. Middle vault collapse correction will restore the aesthetic balance of the face and at the same time restore the functional characteristics of the nose to its full.