title: Split hump technique for reduction of the overprojected nasal dorsum: a statistical analysis on subjective body image in relation to nasal appearance and nasal patency in 97 patients undergoing aesthetic rhinoplasty.
abstract: OBJECTIVE
  To describe the split hump technique (SHT) and to examine its effectiveness for correction of an overprojected nasal dorsum in patients undergoing aesthetic rhinoplasty.
  
  
  METHODS
  This prospective study included 97 patients. Objective assessment was performed using a short, practical questionnaire. Investigation focused on nasal patency and the patient perception of body image in relation to nasal appearance using 5-point Likert scale questions and visual analog scales.
  
  
  RESULTS
  Use of the SHT resulted in a significant improvement in nasal patency and aesthetic nasal perception. Sum functional question scores decreased from 9.154 to 6.351 and aesthetic question scores from 13.897 to 6.825 (P < .001 for both). Mean aesthetic visual analog scale scores improved in all patients, from 3.346 to 7.782 (P < .001). Graphic illustration of this improvement revealed a gaussian curve of normal distribution around a mean (SD) improvement of 4.48 (1.93).
  
  
  CONCLUSIONS
  Traditional en bloc humpectomy maneuvers are frequently combined with spreader graft use to avoid postoperative inferomedial repositioning of the upper lateral cartilages and inverted-V deformity. The SHT for correction of the overprojected dorsum creates a paradigm change in this patient group. The transverse segments of the upper lateral cartilages are saved and repositioned instead of being resected as a part of an en bloc osseocartilaginous composite hump resection in a transverse plane. Several modifications of the SHT enable the surgeon to deproject the nose while keeping sufficient strength in the keystone area and augmenting dorsal width. Using statistical analysis of subjective patient data, we could prove a broad acceptance and appreciation for the SHT.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital Zeist, Zeist, the Netherlands.
authors.forename: Peter J F M
authors.initials: PJ
authors.lastname: Lohuis
authors.forename: Sara
authors.initials: S
authors.lastname: Faraj-Hakim
authors.forename: Arno
authors.initials: A
authors.lastname: Knobbe
authors.forename: Wouter
authors.initials: W
authors.lastname: Duivesteijn
authors.forename: Gregor M
authors.initials: GM
authors.lastname: Bran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001828:Body Image; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055171:Nasal Cartilages / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012225:Rhinoplasty / Q000379:methods* / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult