Purpose of review: The middle vault of the nose continues to be a topic of interest among surgeons interested in aesthetic and functional rhinoplasty. The purpose of this review is to present currently accepted concepts regarding the significance of the middle vault of the nose in rhinoplasty and to review the more frequently advocated methods to be used in the correction of deficiencies. Recent findings: Spreader grafts may be at least as effective as flaring sutures in improving the airway. Studies have shown an improvement in quality of life and nasal breathing with the use of autospreader flaps. The correlation between acoustic rhinometry and clinical symptoms of nasal obstruction, however, has fallen short of providing clear diagnostic value. Summary: The diagnosis of middle vault collapse and nasal valve obstruction remains largely clinical. The patient's reported symptoms of nasal obstruction are diagnostically considered along with the findings of clinical examination, including the findings of a modified Cottle maneuver. The use of spreader grafts and autospreader flaps has been popularized to correct problems in the middle vault of the nose and will be presented in detail in this manuscript.
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