Episode 10 – Podcast Show Notes

🎙️ Dr Dan Behind the Scalpel – Episode: Treatment of the Middle Vault

The middle vault is a critical structural component of the nose and one of the most common sources of functional and cosmetic failure in rhinoplasty. In this episode, Dr Dan focuses on how the middle vault should be treated surgically, why reconstruction is essential, and what happens when it is overlooked.

🔎 What You’ll Learn in This Episode:

• The surgical goals when treating the middle vault.
• Why the middle vault must be reconstructed after rhinoplasty.
• Techniques used to stabilise and support the middle vault.
• How middle vault treatment impacts nasal airflow.
• Common errors that lead to deformity and breathing problems.

🗝️ Key Notes

• The middle vault is formed by the upper lateral cartilages and the dorsal septum.
• Any dorsal hump reduction or septal work will disarticulate the middle vault, requiring reconstruction.
• Key treatment principles include:
  • Restoring width and symmetry
  • Supporting the internal nasal valve
  • Maintaining smooth dorsal lines
• Common surgical techniques include:
  • Spreader grafts to restore support and valve angle
  • Precise reattachment of the upper lateral cartilages
• Failure to properly treat the middle vault can result in:
  • Inverted V deformity
  • Middle vault collapse
  • Persistent nasal obstruction
• These issues are frequently seen when structural grafting is omitted.

💡 Key Takeaway

The middle vault must be actively reconstructed — not ignored. Proper treatment is essential to preserve both nasal function and long-term aesthetic outcomes.

🎧 Listen & Subscribe

Find this episode and more on:

• Spotify
• Apple Podcasts
• Google Podcasts

Follow the show for anatomy-driven insights into safe, effective facial plastic surgery.

⸻

🔥 Social Media Teaser

The middle vault is where many rhinoplasties fail 👃 Dr Dan explains how it should be treated, why reconstruction is mandatory, and how skipping spreader grafts leads to collapse and breathing problems. A must-listen episode.