Whenever I get my new case, I may or may not 120 mm blow hole into the top to clear out hot air. I currently use a Seasonic power supply, and the fan never spins up beyond a gentle breeze, so it's not efficient at removing warm air from my case. It's awesomely quiet, though, which is why I bought it.
It's going to be one of the Antec SOHO server cases, so the airflow will look something like two 80 mm intake at the front and one at the side, with two 80 mm exhaust at the back, plus the small contribution of the power supply fan. I'm planning to run all of the case fans 7-volted, or on a rheobus, to cut down on noise. Since I would rather not run negative pressure inside my case, the 120 mm blow hole, no matter how undervolted, might be overkill. I'm sure I'll have to mess around and see what works best.