Outcome after Dorsal Hump Resection versus Hump Remodeling and Re-insertion: A Randomized Controlled Trial

Abstract

Background: Preservation of the middle nasal vault has become a main concern in primary rhinoplasty surgery. This research elucidates the outcome of the hump re-insertion technique as a method to reconstruct the mid-vault in primary rhinoplasty after dorsal hump resection in comparison to the hump resection with no dorsal grafting technique. Patients and Methods: This study was a randomized controlled trial, conducted on forty patients, divided into 2 groups: Group (A) included 20 patients underwent dorsal hump remodeling and reinsertion, while group (B) involved 20 patients subjected to hump resection with no dorsal grafting. Patients were assessed by the Nasal Obstruction Symptom Evaluation (NOSE) score, the active anterior rhinomanometry, Visual Analogue Scale (VAS) scale and photography. Results: Both groups showed significant improvement in NOSE scores postoperatively. there was a superiority in group A with mean score 23 compared to group B with score 27.5 ( P =0.005 ). 65% of group (A) patients showed improvement to VAS 4 compared to 20% for group B ( P =0.004 ). Postoperative mean nasal airway resistance comparison was statistically insignificant ( P=0.2 ). There was more effective narrowing in dorsal width of nasal bones in group A. Conclusion: Hump remodeling and re-insertion technique is more superior in the aesthetic outcome with more natural looking dorsum and narrowing of the dorsal nasal width. Additionally, it decreases in the need for osteotomies and avoids their consequences. Hump reinsertion is useful as a rescue procedure in case of excessive dorsal resection. Dorsal reconstruction, Hump re-insertion, Primary rhinoplasty.