The First Classification of the Middle Vault Skeleton of the Nose

Introduction & Objective: There is frequent patient complain after crooked nose rhinoplasty operations even in apparently straight noses due to remnant of nasal deviations or asymmetries. Authors believe that middle vault skeletal asymmetry can be the source of these deformities. Introducing a practical classification and addressing the corrective plan for each class may help the surgeons to produce more straight noses post-operatively. Fifty-one rhinoplasty cases were selected randomly. Pre-operative pictures of faces and intraoperative pictures of upper lateral cartilages before and after separation from septum were taken. Hundred and two upper lateral cartilages were analyzed for shape, size and curvature of horizontal and vertical sub-units. Five different shapes were found so we divided them to 5 groups according to topographic characteristics of each cartilage. This pragmatic classification will help the surgeon to be more concern about the middle vault and will have a plan to correct each variation.