Commentary on: The Osseocartilaginous Vault of the Nose: Anatomy and Surgical Observations.

Abstract

The study by Palhazi, Daniel, and Kosins is a thorough anatomical and clinical analysis of the osseocartilaginous vault of the nose. The authors begin the article with some of the finest anatomical dissections of the nose currently in the literature. Their photography and measurements provide a high level of detail. On the basis of the data they collected in the cadaver laboratory, they were able to draw evidence-based conclusions with substantial clinical implications for humpectomy—a persistent problem for many surgeons. For example, they clearly show that whereas the shape of the hump is determined largely by the cartilaginous component prehumpectomy, the sides of the resultant nasal bones, posthumpectomy, determine the dorsal aesthetic lines. This anatomic finding reinforces the need to fashion the bones as much as or more than the cartilages to create the desired dorsal aesthetic lines. They also introduce the concept that the bony component of the dorsal hump should be thought of as a “cap” covering the cephalic part of the cartilaginous hump. They make the case that this cap can be removed easily enough with a rasp, although they indicate later in the paper that they occasionally use a power tool. This description is, perhaps, the single most important practical contribution from their anatomic studies. It provides encouragement for the beginning rhinoplasty surgeon to duplicate this seemingly atraumatic technique …