title: Autospreading spring flap technique for reconstruction of the middle vault.
abstract: BACKGROUND
  Reconstruction of the middle third of the nose is crucial and middle vault insufficiency is possible following dorsal reduction in a primary rhinoplasty unless additional surgical measures are taken. The aim of this study was to define a novel suturing technique autospreading spring flap for middle vault reconstruction by suturing only the medial aspect of both upper lateral cartilages with septal quadrangular cartilage in a unique mattress suture and to mimic the natural anatomical configuration of the upper lateral and septal cartilages. This technique is intended to create functionality with aesthetic dorsal lines.
  
  
  METHODS
  Fifteen volunteers with a significant osseocartilaginous dorsal hump underwent open rhinoplasty. The middle vault was reestablished using the ASSF technique that appositions only the medial part of the upper lateral cartilages and suturing it to the dorsal septal cartilage. Appearance of the nose before and after the operation was evaluated by the patients using a visual analog scale. Acoustic rhinometry (AR) was carried out preoperatively and postoperatively to determine nasal valve patency. Preoperative and postoperative symptoms were evaluated and compared using the nasal obstruction symptom evaluation (NOSE) scale.
  
  
  RESULTS
  Patients (mean age=32.2±6.3 years) were followed for a mean of 12.6 months. The preoperative NOSE score was 65.0±13 and the postoperative NOSE score was 7.7±10. Cosmetic evaluation revealed the mean patient preoperative VAS score was 32.5±20 and the postoperative VAS score was 88±9. AR revealed a mean minimal cross-sectional area of 1.56 cm2 that increased to 2.16 cm2 postoperatively. Intranasal total volume increased from 16.3 to 24.8 cm3 postoperatively.
  
  
  CONCLUSIONS
  The newly defined autospreading spring flap suturing technique is a reliable method for reconstructing the nasal dorsum after humpectomy and for preventing middle vault and nasal valve collapse. The outcome was satisfactory, both aesthetically and functionally, but long-term follow-up is required.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Bezmiâlem Vakif University, Fatih, Istanbul, Turkey.
authors.forename: Sabri Baki
authors.initials: SB
authors.lastname: Eren
authors.forename: Selahattin
authors.initials: S
authors.lastname: Tugrul
authors.forename: Berke
authors.initials: B
authors.lastname: Ozucer
authors.forename: Aysenur
authors.initials: A
authors.lastname: Meric
authors.forename: Orhan
authors.initials: O
authors.lastname: Ozturan
mesh_terms: D000328:Adult; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055171:Nasal Cartilages / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery; D009666:Nose / Q000002:abnormalities / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D023842:Rhinometry, Acoustic / Q000379:methods; D012225:Rhinoplasty / Q000379:methods*; D018570:Risk Assessment; D012494:Sampling Studies; D013524:Surgical Flaps / Q000098:blood supply*; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome