Computational Analyses of Physiologic Effects After Midvault Repair Techniques in Rhinoplasty


<jats:sec><jats:title>Background:</jats:title><jats:p> Midvault reconstruction is an essential element of functional rhinoplasty. An improved understanding of airflow patterns after spreader graft (SG) or spreader flap (SF) techniques can inform surgical techniques based on individual anatomy. </jats:p></jats:sec><jats:sec><jats:title>Objectives:</jats:title><jats:p> The objective of this study was to compare the physiologic changes related to nasal function after midvault reconstruction with SF and SG. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Soft tissue elevation (STE), SG, and SF were performed in sequence on 5 cadaveric specimens. Computational modeling was used to simulate airflow, heat transfer, and humidity in three-dimensional nasal airway reconstructions of each specimen. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Median bilateral airflow-rates (L/min) were similar for STE (29.4), SF (27.6), and SG (28.9), and were not statistically significant (STE vs SF: P = 1.0, power = 5%; STE vs SG: P = .31, power = 16%; SF vs SG: P = .42, power = 14%). Both SF and SG had increased unilateral airflow volume (L/min) through the more obstructed nasal passage (median: STE 10.3, SF 12.2, SG 12.7), but these differences were not significant (STE vs SF: P = .19, power = 24%; STE vs SG P = .19, power = 30%). Furthermore, SF and SG had decreased unilateral nasal resistance (Pa s/mL) on the more obstructed side (median: STE 0.085, SF 0.072, SG 0.062) (STE vs SF: P = .13, power = 23%; STE vs SG P = .13, power = 24%). For all 3 models, heat flux distribution was greater in the anterior portion of the nasal passage than the posterior portions. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Differences in nasal airflow and resistance after SF and SG were not statistically significant, but both procedures resulted in higher airflow rates and decreased nasal resistance through the more obstructed nasal passage. </jats:p></jats:sec>






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Publication Info

Avashia, YJ, HL Martin, DO Frank-Ito, KZ Hodges, RT Trotta, H Li, C Lowry, CR Woodard, et al. (2023). Computational Analyses of Physiologic Effects After Midvault Repair Techniques in Rhinoplasty. FACE, 4(1). pp. 22–32. 10.1177/27325016221138749 Retrieved from

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Dennis Onyeka Frank-Ito

Associate Professor in Head and Neck Surgery & Communication Sciences

My research interests include modeling the effects of human airway anatomy on respiratory airflow patterns, deposition of inhaled gases and particle transport using computational fluid dynamics.


Charles Woodard

Associate Professor of Head and Neck Surgery & Communication Sciences

I am an Associate Professor and Division Chief of Facial Plastic & Reconstructive Surgery as well as Division Chief of Comprehensive Otolaryngology for the Department of Head and Neck Surgery & Communication Sciences.  I also serve as the Otolaryngology Residency Program Director and Chair of Accreditation Subcommittee for Duke Graduate Medical Education.  My clinical interests include aesthetic and functional reconstruction of the face.  My research has focused on value-base care, quality improvement through outcomes analysis, interdisciplinary facial plastic surgery education, opportunity costs of craniofacial trauma care, computational fluid dynamics evaluation of the nasal airway, and optical spectroscopy evaluation of cutaneous malignancies.  An important component of my career success lies in leadership development, so I may remain effective in my current roles at Duke. 


Alexander C Allori

Associate Professor of Surgery

Pediatric plastic and craniofacial surgeon, taking care of children with cleft lip/palate and other facial differences.

Dedicated to the improvement of multidisciplinary team-based care, especially by way of standardized, prospective outcomes measurement ("If you don't measure it, you can't improve it.")

Passionate about using causal inference methods to improve observational studies.


Jeffrey Robert Marcus

Professor of Surgery

My research parallels our specialized clinical programs at Duke. I am involved in clinical research looking comprehensively at outcomes of cleft care to develop standards for evaluating a team’s overall success. Based on a recent grant from the Centers for Disease Control (CDC), we are also participating with several centers to look specifically at academic, psychosocial, and surgical outcomes for all children with clefts born in North Carolina. We are committed to the technique of nasoalveolar molding for children with clefts and are engaged in analyzing its benefits. In rhinoplasty, we have developed a model for nasal respiratory physiology, and we are looking at the effects of specific surgical procedures on nasal airflow and resistance. Our Craniofacial imaging lab has developed sophisticated software to analyze cranial shape, and we use these techniques to define abnormal conditions and their treatment relative to normal. Lastly, our craniomaxillofacial trauma team continues to look at factors associated with facial trauma in North Carolina in order to implement techniques and processes to deliver optimal care and results.

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