Practical Classification of Upper Lateral Cartilage in Middle Vault Asymmetry.

BACKGROUND: Middle vault asymmetry is a common reason for retained postoperative deviations. Although minor deformities can be camouflaged with cartilage, soft tissue materials, or injectable fillers, comprehensive observation of upper lateral cartilage (ULC) and subsequent topographic classification in major anatomical anomalies will help surgeons better plan their procedures to obtain better symmetry. METHODS: Photographs of 71 randomly selected primary open rhinoplasy patients were analyzed for anatomic presentation of their ULC. Pictures were taken before and after separation of ULC from the septum. ULC was classified from Class I to Class V according to the width of the transverse subunits and curvature of the vertical subunits. RESULTS: We observed 142 ULCs of 71 rhinoplasty patients. ULC was classified as follows: Class I: 53 cases; Class II: 3 cases; Class III: 40 cases; Class IV: 36 cases; and Class V: 10 cases. CONCLUSIONS: ULC asymmetry is a common occurrence in rhinoplasty, and the ULC itself may be the source of nasal deviation. The middle vault requires special attention, and establishment of a classification system could enable surgeons to devise an effective plan for correction and prevention of retained postoperative nasal deviation.