title: Combined use of triple cartilage grafts in secondary rhinoplasty.
abstract: Secondary rhinoplasty on a patient with a middle vault deformity is one of the most challenging procedures for a plastic surgeon. In order to achieve proper nasal aesthetics and airway function, a surgeon most commonly chooses to engraft the nose with a spreader, dorsal onlay, or columellar graft. This paper examines the aforementioned techniques in the management of 25 patients who presented with a severe middle nasal vault deformity.
  
  
  METHODS
  During the last 5 years, 25 patients received secondary rhinoplasty using triple cartilage grafts to repair severe middle vault deformities. Patients were then questioned at least 3 months postoperatively about both airway problems and cosmetic satisfaction.
  
  
  RESULTS
  All the 25 patients indicated cosmetic satisfaction with 23 of the patients also achieving complete nasal airway function. Only two patients persisted to have an insufficient nasal airway. An endonasal examination revealed a slight nasal synechiae in one patient, while no anatomic problem was identified in the second patient. From a cosmetic standpoint, a straight dorsum with improved dorsal aesthetic lines and nasal profile, along with nasal-facial balance were achieved. When indicated, secondary rhinoplasty to repair a middle vault deformity using the combination of spreader, dorsal onlay, and columellar grafts to augment the nose has shown to have both functional and cosmetic benefits.
authors.affiliation: Mersin University Medical School, Department of Plastic and Reconstructive Surgery, Zeytinlibahce Cad., 33079 Mersin, Turkey. arslane@mersin.edu.tr
authors.forename: Emrah
authors.initials: E
authors.lastname: Arslan
authors.forename: Christopher
authors.initials: C
authors.lastname: Majka
authors.forename: Volkan
authors.initials: V
authors.lastname: Beden
mesh_terms: D000293:Adolescent; D000328:Adult; D002356:Cartilage / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D009296:Nasal Cavity / Q000503:physiopathology; D009666:Nose / Q000503:physiopathology / Q000601:surgery; D009667:Nose Deformities, Acquired / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D012225:Rhinoplasty / Q000379:methods*; D016896:Treatment Outcome