Can a Large Dorsal Hump Be Removed with Rasping Alone?

The main problem with an open roof deformity is the appearance.  If you have doubts about this surgeon, seek another opinion.  However, if you go searching for an opinion that you want to hear, you will find it and it may not be the right answer.  In general, smaller humps can be handled with rasping alone and larger ones require fracturing.

The nose is a pyramid. Removing a large hump is akin to chopping the top off the pyramid. If the sidewalls aren't closed then the top of the bones are splayed apart. That is called an open roof deformity. Some surgeons have euphamisms for not breaking the bones such as "micro-osteotomies" but that is really the same thing. "Breaking the bones" acually yields a better result and does not add any risk. You will have black and blue eyes for a few days longer but a better looking nose for the rest of your life.

Hi,

If you have a large hump with bone and cartilage, just rasping and removing cartilage will set you up for an open roof deformity. Just think of cutting the roof of a house horizontally: the walls have to come in to prevent an open roof. You should have osteotomies to bring the nasal walls in. If it is a small hump, you may get away with just rasping and cartilage removal.

Best,

Dr.S.

Once a large dorsal hump has been removed it will create an open roof deformity since the left and right nasal bones will not be touching the septum.  This creates an open roof deformity, which is referred to a flat top effect.  To prevent this from occurring, both medial and lateral osteotomies must be performed.  The open roof deformity will not cause any physiologic problems, however it will be an undesirable effect cosmetically.

Dear Jerry,

Without photos and physical examination it is hard to give you a solid opinion about your case.

An osteotomy may be the way to go supplemented with in-fracturing of the bone.

It is important that a harmonious approach is to be adopted to keep your results as natural as possible fitting your facial features.

I encourage you to seek a consultation with a board certified surgeon of extensive experience in Rhinoplasty so you can make a well informed decision.

Best of luck to you and thank you for your question.

Dr. Sajjadian

If you have seen work the surgeon has done and you are comfortably with him, I would recommend you follow his advice.  Many patients wish to avoid having their nasal bones broken because the thought of it freaks them out.  In reality, however, nasal fracturing is a very controlled procedure and does not cause a lot of pain.  If your surgeon recommends fracturing the nose, I would agree to it.   Many rhinoplasties I have revised needed the revision at least in part because adequate infracture was NOT performed.  So if you trust the surgeon, you should let him make the determination.

From this side of the computer it is impossible to know if you were mislead or misunderstood what was being said. The hump is made of variable portions of cartilage and bone. To remove the hump the bone is usually rasped or filed down and the cartilage is usually cut. If the height of the hump being removed is more than a few millimeters that usually results in a flat open area along the top of the bridge. That open area is closed by either moving the bones on the sides of the nose toward the midline or tipping the upper edges of those bones together. The first narrows the bridge the second does do so to such a great extent. The open roof is a cosmetic defect and should not cause any functional problems.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Hi 

The nasal hump surgical treatment cN be classified to two options

1. Small to moderate nasal hump, which can be treated by rasping . Either through the classic rhinoplasty or even just through a closed approch without opening the skin.

2. Moderate to large  humps that need to be rasped, resected, or ostetomised. In those cases, the open roof will be a problem if left untreated. 

The  usual treatment is the lateral ostetomy, and if that is not an option a cartilage graft can be used to close that defect.

Good Luck

It would be difficult to give you an exact answer with examination and photos. In general, with a small hump removal can be done with rasping and that may all you need. In a larger hump, open roof deformity will happen and will need bilateral osteotomy and possible spreader grafts. It so only with proper examination the appropriate procedure is determined.

Open roof deformity is a cosmetic problem where there is a gap in between the nasal bones which may be palpable or visible if the skin retracts into it. Nasal bone fracture, or osteotomies, is used to correct or prevent this problem.  If the dorsal hump is small enough and narrowing of the nasal bones is not requires esthetically, then osteotomies may not be needed.  Another issue to consider with large dorsal hump reductions is the stability of the cartilaginous dorsum.  Most dorsal humps have cartilaginous component which needs to be reduced as well.  This may lead to the weakness of the cartilaginous dorsum and collapse of the upper lateral cartilages (so called inverted V deformity) causing nasal obstruction. Any experienced rhinoplasty surgeon can determine whether any additional steps, such as osteotomies or reinforcement of the cartilaginous midvault, will be required following reduction of the dorsal hump.