Management of the Mid-vault

  • Ahmet Biçer
  • Özge Bilkay
  • Ufuk Bilkay


Phylogenetic features of human populations across the globe are not as diverse as one may think. This is mainly because the major source of diversity can be observed causally in soft tissue envelope and skin features, unlike skeletal features and the genome. There are several factors hypothesized to be contributing to the current form and size of the human external nose, which took place rather recently in evolutionary terms. Changes in the dietary habits diminished the size and robustness of the jaws and development of speech that resulted in the narrowing of the upper aerodigestive tract, both of which led to a protruding external nose in the midfacial region. Evolutionary biologists see the external nose not only an organ for warming and humidifying breathed air but also an ornament of sexual selection. Sexual dimorphism appears mostly during puberty: a period of high concentrations of circulating sex hormones. The mid-vault region and cartilaginous septum are somewhat more receptive to those hormones than that of the lobule and nasal bones causing septal deviations, crooked shape, tension nose, and dorsal humps, which are not apparent until puberty. Regardless of our point of view on the evolutionary and adaptive foundations of bearing a prominent, pendulous external nose, almost all dimensions, form, and balance are dictated by a region where all ends meet: the middle vault. Being a major component of vertical and horizontal dimensions and symmetry, the middle vault (or the cartilaginous vault) is the static backbone of a successful rhinoplasty operation, both on the table and on photographs. Furthermore, the middle vault, bearing the internal nasal valve and perinasal muscles, is also critical for a dynamic, natural, and functional rhinoplasty result. In this chapter, the basic science, patient assessment, management, complications, and problem-solving regarding the middle vault are discussed.


Mid-vault Rhinoplasty Management Complications Problem-solving 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ahmet Biçer
    • 1
  • Özge Bilkay
    • 2
  • Ufuk Bilkay
    • 1
  1. 1.Faculty of Medicine, Department of Plastic, Reconstructive, and Aesthetic SurgeryEge UniversityİzmirTurkey
  2. 2.Department of OtorhinolaryngologyAlsancak State HospitalİzmirTurkey

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