Spare Roof Technique Versus Component Dorsal Hump Reduction: A Randomized Prospective Study in 250 Primary Rhinoplasties, Aesthetic and Functional Outcomes

Abstract

Background The majority of Caucasian aesthetic rhinoplasty patients complains about a noticeable hump in the profile view. Based on the integrity of the middle vault, there are two ways to dehump a nose: the structured technique and the preservation technique. Objectives We compared the aesthetical and functional outcomes of two techniques utilized for reduction rhinoplasty. Methods We performed a prospective, randomized, interventional, and longitudinal study on 250 patients randomly divided into two groups: the component dorsal hump reduction group (CDRg) (n = 125) and the spare roof technique group (SRTg) (n = 125). We utilized the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty. Patients answered the questionnaire before the surgery, and at 3 and 12 months after surgery. In addition, we utilized a Visual Analog Scale (VAS) to score nasal patency for each side. Results Analyses of the preoperative and postoperative aesthetical VAS scores showed a significant improvement in both groups, from 3.66 to 7.00 (at 3 months) and to 7.35 (at 12 months) in CDRg, and from 3.81 to 8.14 (at 3 months) and to 8.45 (at 12 months) in SRTg. Analyses of postoperative means of aesthetic VAS scores showed a significant improvement in both groups over time. However, aesthetical improvement was higher in SRTg than CDRg, concerning 3 (P < .001) and 12 months (P < 0.001) postsurgery. Analyses of the mean functional VAS scores showed a significant improvement in both techniques, with a better result for SRTg. Conclusions The spare roof technique (SRT) is a reliable technique that can help deliver consistently better aesthetical and functional results in reduction rhinoplasty over component dorsal hump reduction CDR in Caucasian patients with dorsal hump.

Global Practice Patterns of Dorsal Preservation Rhinoplasty

“…34 A modified osseocartilaginous preservation technique (''spare roof technique'') has shown to have better aesthetic and functional results over component dorsal hump reduction. 39 We also have ongoing studies that demonstrate equivalent, if not superior, aesthetic outcomes with DPR techniques. In addition, we have shown that DPR can be combined with anterior septal reconstruction in cases of severe caudal septal deviation.…”

Clinical Benefits of the Utrecht Questionnaire for Aesthetic Outcome Assessment in Rhinoplasty: An Update

“…The benefits were first demonstrated in a pilot study by reporting a significant improvement in UQ postoperative scores of 100 consecutive patients treated with this technique 11 . This finding was later strengthened by conducting a comparative study that included 250 subjects in which a significantly higher improvement in UQ scores was observed in patients undergoing Spare Roof Technique compared to patients treated with traditional Component Dorsal Reduction 12 . This work was presented as part of the thesis for his doctorate, which was granted by Universidade do Porto in 2020.…”

Commentary on “Middle Vault Changes After Humpectomy by Spare Roof Technique Versus Component Dorsal Hump Reduction” by Dias et al: Which Method of Dorsal Preservation Rhinoplasty Is Best?

“…3 In a strict sense, the spare roof technique (SRT) does not fall under the category of complete dorsal osseocartilaginous preservation rhinoplasty (DPR), as it involves obligatory removal of the bony cap, osteotomies as well as routinely recommended dorsal camouflage with diced or sliced cartilage grafts. 4 Still, the concept of preservation of the midvault is central to both DPR and SRT.…”

“…The SRT, as originally described, involves removal of the dorsal and lateral keystone areas, as well as osteotomies, much like standard component reduction. 4 The advantage of the technique is that the strength of the dome of the T-shaped middle-vault structure (septum and upper lateral cartilages, which some argue are a single entity) is preserved. That is, the subdorsal septal resection does not violate the ''dome'' of the midvault.…”

“…To that end, the senior author has contributed prospective studies on the SRT, including a recently published prospective trial comparing SRT and CDR. 4 Although visual analog scale and a rhinoplasty selfimage scale were used, an instrument specific to nasal form was not. So, the questions of technique superiority are clearly not simple and cannot be answered by a single study.…”