The Boomerang Mid-Septal Excision and Sliding Advancement Septal Flap with Dorsal Roof Preservation.

Abstract

Dorsal preservation techniques balance hump reduction with mid-vault support. Foundation techniques (impaction) lower the dorsal hump without reshaping it, whereas surface modulation can compromise vault support. We propose an intermediate approach-boomerang mid-septal excision with intermediate osteotomies-that straightens the dorsum while preserving the keystone area and dorsal aesthetic lines. A retrospective case series of 50 patients who underwent rhinoplasty between July 2021 and march 2024 using the following operative technique: (1) boomerang-shaped mid-septal cartilage excision, dividing the septum into anterior and posterior segments; (2) osteotomy or ostectomy of the nasal bones at the nasomaxillary suture in a pre-designed pattern; (3) sliding caudal advancement of the anterior septal flap to straighten the osteocartilaginous hump; and (4) fixation of the bone and cartilaginous segments. Clinical examinations and digital photographs were used to document progression, stability of results, and complications. At a mean 18-month follow-up, dorsal straightening was maintained in 38/50 (76%); no defects or irregularities were noted at the intermediate bony work. The proposed technique may, in selected cases: 1) facilitate single-unit dorsal straightening with limited soft-tissue dissection for a smoother contour; 2) broaden the bony hump morphologies amenable to preservation; 3) provide a caudally advanced septal flap for nasal lengthening or tip support when indicated; 4) supply a boomerang cartilage graft for adjunctive maneuvers; and 5) allow stabilization of the straightened dorsum through suture fixation of both bony and cartilaginous segments.