Hump removal techniques

1. DORSAL REDUCTION
RHINOPLASTY
DR. SNEHLATAJR2

2. ANATOMY OF NASAL DORSUM

3. ANATOMY OF NASAL DORSUM
● The nasal dorsum is the bridge of the nose, extending from the bony prominence at the forehead (nasion) to the
nasal tip.
● It is composed of both bone and cartilage.
● The upper two-thirds of the dorsum is primarily bone, while the lower third is mainly cartilage.
● A dorsal hump is a bump or protuberance on the nasal dorsum.

4. 1)The bony and cartilaginous skeleton is covered by the skin and
subcutaneous tissue, together with a connective tissue layer which
envelopes .
2)This layer of connective tissue and the muscles of the nose can be seen
as an extension of the facial superficial musculoaponeurotic system
(SMAS)
3)All the vessels, both venous and arterial are running in and underneath
the SMAS layer. When surgery of the framework of the nasal dorsum has
to be performed, one should dissect in an avascular thin multi layer sliding
plane close to the perichondrium

8. TYPES OF HUMP

10. CARTILAGINOUS HUMP
convexity here is limited to the cartilaginous dorsum. The cartilaginous complex is
composed of the septum and the upper lateral cartilages (ULCs).

11. BONY AND CARTILAGINOUS HUMP
Both the bony and the cartilaginous dorsa are convex (humped)
In this case both the bony vault and the cartilaginous vault reduction are done in a systematic
manner:

12. ONLY BONY HUMP
the convexity is confined only to the bony pyramid

13. PSEUDO HUMP
A pseudo hump refers to a nose in which the radix is underdeveloped.
which leads to a profile in which the tissue below the radix appears even fuller
and underprojected than it really is.
Pseudo Hump can be produced by either soft tissue fullness or bone.

14. INTRODUCTION TO DORSAL REDUCTION
RHINOPLASTY
1)Removal of a hump is a frequent procedure in rhinoplasty.
2)etiology is usually congenital or familial, a nasal hump can also be the result of trauma
with dislocation of the nasal bones and/or callus formation.
3)The overprojection can be in the upper third (= bony pyramid); middle third (=
cartilaginous pyramid) or it might be a combination of both. Usually the bony part of the
hump is smaller than the cartilaginous part.
4)Depending on the individual anatomy, surgery needs to deal with the nasal bones,
septum, and upper laterals, and one has to correct the part that is overprojected.

16. CANDIDATES FOR DORSAL REDUCTION
RHINOPLASTY
● Individuals with a dorsal hump that they find aesthetically
displeasing
● Individuals with a dorsal hump that causes breathing
problems
● Individuals who have had a previous rhinoplasty that did
not address the dorsal hump

24. TECHNIQUES
1)DEHUMP
2) OSTEOTOMIES
3)SPREADER GRAFT

32. CARTILAGE HUMP REDUCTION
. segmental to an en bloc resection of the hump.
split hump technique:(a) Retraction of the skin flap in the avascular supraperichondrial plane.
(b)Meticulous elevation of the mucoperichondrial layers on both sides of the septum to avoid a
mucosal injury when reducing the dorsum. This will result in a more controlled and faster
healing process.
(c) A vertically positioned No. 11 blade is inserted underneath the cartilaginous vault, carefully
avoiding trauma to mucoperichondrial flaps.
(d)Using paraseptal vertical incisions, the entire ULCs are bilaterally separate from the
septum.
(e) Straight scissors or a No. 15 blade is used to reduce or shave the dorsal height of the
septum.
(f)Judicious reduction of the bony dorsum is done using a rasp rather than an osteo- tome.
Then, the underlying cartilage is

40. Reduction of bony hump can be managed by
(a) Rasping:
rasp removes the bone only while being removed.
(b) Drilling with a diamond burr.
(c) Piezoelectric Device.
(d) Osteotomy using osteotomes and realigning.
Paramedian, lateral and transverse osteotomies are done. Bony vault is mobilised as
required and modified depending on the size of the hump. Free diced cartilage is used for
minor irregularities.

44. ONLY BONY HUMP
1)convexity is confined only to the bony pyramid.
2)Rasping, drilling or piezoelectric device is used.
3)Osteotomy is performed depending upon the nasal width.
4)smoothening of the hump helps in small bony deformities.
5)post-operative irregularities encountered if proper smoothening of the hump
is not done.
6)In case of small irregularities, free diced cartilage will help. As an additional
advantage, it helps to prevent adherence of the skin to the bone and prevent
pain.

45. Osteotomies
Purpose of osteotomies
a) reduce convexity of lateral side of nose
b)reshape base of nose

62. SPREADER GRAFT
1)Spreader grafts are used to treat or prevent internal valve collapse in primary cases
2)VALUABLE FOR MAINTAINING WIDTH OF CARTILAGINOUS VAULT
3)To stabilise the nasal dorsum
EXTENDED SPREADER GRAFT ;
USED WHEN NASAL LENGTHENING NEEDS TO BE DONE

73. Complications of treating hump nose

75. a)ski slope nose the open roof is due to insufficient reconstruction of the dorsum
by spreader flaps .
involving both the bony and cartilaginous parts as a result of excessive hump
removal, especially in the K area.
:inadequately supported caudal septum can also be responsible for this deformity.
:can be prevented by paying attention to the reduction of the lower bony dorsum
and not forgetting to fix the cartilaginous septum to the anterior nasal spine
.
(b) inverted v deformity : Inverted V deformity can be prevented by placing
spreader grafts to prevent the loss of stability at the “K” area
(c)small irregularities ; this can be correct by diced cartilage
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