Radix and Dorsum

Abstract

The radix and dorsum are fused anatomically, aesthetically, and surgically. For the vast majority of patients, their three main complaints in order of importance are the “bump” on profile, the lack of tip definition, and the wide nose. Thus, two of three complaints are located in the radix and dorsum. Anatomically and embryologically, the bony vault and the cartilaginous vault are a single entity – the osseocartilaginous vault (hereinafter the dorsum). The key to designing the optimal surgical solution is the nasofacial angle (NFA), which most surgeons consider to be the most important aesthetic angle in the entire face. The setting of the ideal nasion point determines the nasofacial angle and also whether the radix area needs to be augmented or reduced. Equally, the line connecting the nasion to the tip reveals the need for dorsal modification. This linkage is expressed in the “balanced approach” to the dorsum. For example, a radix augmentation decreases the amount of dorsal reduction required thereby preserving a more natural profile. Osteotomies to nar row the bony vault are neither an automatic maneuver nor a single technique. The cartilage vault requires equal emphasis with spreader grafts done to preserve function and to improve aesthetics. Failure to stabilize the midvault can lead to a visible inverted-V deformity with internal valve collapse. The importance of understanding the dorsum and selecting the optimal operation is obvious in examining a large number of secondary rhinoplasty patients where the sign of a “nose job” is now dorsal deformities rather than tip problems.