Docile Splay graft for middle vault reconstruction

Abstract

he internal nasal valve plays a crucial part in both the aeshetic appearance and function of the nose after rhinoplasty nd many techniques have been introduced for reconstructing t, each of which has its own advantages and disadvantages. e present a technique for reinforcement of the internal nasal alve that we think would be beneficial to most patients who ave primary or secondary rhinoplasty. During the classic dorsal refinement the upper lateral carilages are stripped off the septum to give enough access to he septal cartilage, and care is taken to preserve the integrity f the underlying mucosa when the upper lateral cartilages re dissected a few millimetres from the underlying mucosa. A small piece of septal cartilage is placed in the cartilage rusher and with a few gentle strokes of the mallet on the carilage crusher the graft is moderately crushed and the elastic trength minimally reduced. The extent of crushing may be hecked between each mallet stroke. The crushing is equal o level two of the crush grading described by Cakmak and uyuklu to make a thin homogeneous pliable piece of cartiage, which is trimmed and tailored to provide a rectangular raft.1 The graft is placed over the dorsal septum between the wo edges of the upper lateral cartilages (Figs. 1–3) and a skin ap is turned back so that the surgeon can assess the aesthetic esult and correct any sharp edges. This step may be repeated everal times to adjust the size and shape of the graft, and hen the upper lateral cartilages are gently reapproximated ith a 5/0 polydioxanone suture.