Dorsum

Abstract

Dsum is approached. Surgeons use the term dorsum to refer to the osseocartilaginous vault, which is a fixed entity combining both bony vault and cartilaginous vault. Modifications to the vaults require careful assessment of aesthetics and functional factors, particularly regarding the internal valve angle. Aesthetically, the dorsum is often seen as a concave (female) or straight (male) line connecting the nasion with the tip. This concept can have grave consequences if the tip is underprojecting and one over-reduces the dorsum to fit a dependent tip. Alternatively, one should conceptualize the dorsum as having an ideal height and being an integral part of the nasofacial angle rather than as a mere interconnecting line. On analysis, one should see the parallel dorsal lines and any deviations as well as appreciate the base bony width. Asymmetries of the parallel dorsal lines are corrected using spreader grafts of different widths rather than asymmetric lateral osteotomies. For many years, surgeons reduced virtually every nose and made the “dorsum fit the tip.” It is only recently that the “balanced rhinoplasty” concept has been widely accepted, and a natural dorsum has been achieved. Also, the primary purpose of lateral osteotomies has shifted from closing the “open roof” to narrowing the base bony width. Equally, the number and magnitude of osteotomies have been reduced with very few medial osteotomies and virtually no out fractures being done. This evolution has led to fewer over-resected dorsums and rhinoplasty cripples that plagued the reduction-only era.