# Supraseptal groove fold-in flap for the reconstruction of middle vault in primary rhinoplasty

## TL;DR

A new rhinoplasty technique using the supraseptal groove improves nasal function and appearance by supporting the middle vault.

## Contribution

A novel fold-in flap technique using the supraseptal groove for middle vault reconstruction in primary rhinoplasty is introduced.

## Key findings

- The technique significantly improved both functional and aesthetic outcomes compared to preoperative assessments.
- The flap helped correct nasal deviation while preserving cartilage.
- Results were evaluated using questionnaires and showed significant improvements (P < 0.01).

## Abstract

During primary rhinoplasty, dorsal hump reduction almost always impairs the middle vault and if not reconstructed nasal obstruction is likely to occur.

The aim of this study is to suggest a novel technique that can utilize supraseptal groove as fold-in flap to widen and support the middle vault for better functional results.

Between November 2019 and November 2022, 232 patients operated utilizing supraseptal groove fold-in flap technique using open rhinoplasty approach was retrospectively examined. Supraseptal groove and upper part of the upper lateral cartilages were folded in toward the septum to widen and support the middle vault. Uneven split of the supraseptal groove was performed in favor of the deviation if there was a deviation present. Transcartilaginous horizontal mattress sutures were used if the flap was not stable. Functional results were compared by using Nasal Obstructive Symptoms Evaluation questionnaire whereas subjective Esthetic Appearance test for the esthetic outcomes were administered.

The mean age was 37.1 years (18–63 years), and the mean follow-up time was 18.8 months. Both functional and esthetic outcomes were significantly better in all categories compared to the preoperative assessments (P < 0.01).

Supraseptal groove fold-in flap for the reconstruction of middle vault is an effective and promising technique meanwhile preserving as much as cartilage possible in primary rhinoplasties. While widening and supporting mid cartilaginous vault, it can also help to correct the nasal deviation if present.