Alar Batten Grafts Research Articles

Septal Extension Spreader Graft Combined With Warped Alar Batten Graft for Improvement of Nasal Tip and Alar Asymmetry in Adult Cleft Lip Nasal Deformity.

This paper presents the findings of an observational study involving 38 patients to evaluate the application of a surgical technique utilizing an autologous costal cartilage scaffold for correcting nasal tip and alar asymmetry in unilateral cleft lip-nasal deformity. Nasal septum extension spreader grafts (SEG) and warped alar batten grafts, both made from autologous costal cartilage, were utilized in open rhinoplasty procedures. The warped alar batten graft was fixed to the caudal end of the SEG, with the lower lateral cartilage on the cleft side suspended to the free part of the newly created warped alar batten graft to lift the collapsed nasal alar further. Measurements of nasal tip height, nostril height, and the intersection angle of the nasal sill and alar (α) were taken before and after surgery, comparing the ratios between the normal and cleft sides. Patients were followed up for 2.5 to 5.5 years, with all cases showing successful healing and no complications. Postoperative improvements in nasal tip and nostril asymmetries were significant, with statistically significant changes observed in nasal tip height, nostril height, and the intersection angle of nasal sill and alar (α) ( P <0.05). The combined use of SEG and warped alar batten graft, both crafted from autologous costal cartilage, effectively corrected nasal tip and alar asymmetry in adult cleft lip nasal deformity cases.

Rhinoplasty Exclusively Utilizing Autologous Costal Cartilage for Patients with Prior Unilateral Cleft Lip Repair.

Rhinoplasty in patients with previous unilateral cleft lip repair is a surgical challenge due to complex nasal deformities, including a horizontally positioned nasal wing, wide cleft side nostrils, nasal base defects, and a short and deviated nasal columella. To comprehensively address these complexities, we exclusively utilized autologous costal cartilage in rhinoplasty procedures, using various surgical techniques. This study presents a comprehensive case series of 39 patients who had previously undergone unilateral cleft lip surgery but still had nasal deformities. Rhinoplasty using autologous costal cartilage was performed at Cho Ray Hospital, Vietnam. Costal cartilage was partially crushed and then finely cut to shape the dorsal area and raise the nasal base on the cleft side. Partially crushed cartilage was also used to shape shield grafts, cap grafts, and alar batten grafts, whereas sliced cartilage was utilized for septal extension grafts. Evaluation was based on improvements in anthropometric indicators, patient satisfaction using Rhinoplasty Outcome Evaluation (ROE) scale and FACE-Q scores. The average age of patients was 25.13 years. All postoperative anthropometric indicators showed significant improvements. Postsurgery, the total ROE score was three times higher than before surgery (P < 0.001), and the total FACE-Q score was 2.26 times higher (P < 0.001). No significant intraoperative or postoperative complications were observed. This procedure effectively addresses complex nasal deformities in patients with prior unilateral cleft lip repair, emphasizing the value of autologous costal cartilage in rhinoplasty for such individuals.

Step by Step of a Creative Template for Rhinoplasty Training in Chicken Breast

Introduction: Rhinoplasty is a challenging surgery and provides balance, harmony, and symmetry to the face, so it should always be following the exact measurements and plan. Variations in techniques, measurements, and photographic studies have represented the surgeon's work tripod to optimize the aesthetic and functional results of nasal surgery. Furthermore, the creative template for rhinoplasty training will provide the young surgeons improve their practice and develop manual skills. Objectives: To demonstrate the rhinoplasty surgical sequence in a cadaveric animal (chicken) with an objective, systematic, and reproducible way for training the young surgeons. To establish grafts measurements in a clear, readable, and effective way. Casuistic and Method: This research is a prospective study for training the rhinoplasty technique in a cadaveric animal (chicken). The systematization of the surgical sequence in the animal model manufacture grafts for rhinoplasty in an objective way to simulate the nose. The breasts of cadaveric chickens coated with leather were selected and treated in the laboratory in São Paulo, Brazil. The models were photographed and filmed to record the stages of the grafts creation, such as spreader graft, columellar strut graft, shield graft, onlay graft, septal extension graft, alar batten graft, lateral strut graft, alar rim graft, free diced cartilage, combined graft, cap graft, and pump graft. The surgical materials are the same used in rhinoplasty, only in a small amount. Result: Surgical simulation model chicken sternal cartilage provides enough cartilage to practice rhinoplasty sculpting without involving live humans or human cadavers. The cartilage is abundant and properly to simulate the nose. The creative template is a clear, legible, and effective training of rhinoplasty grafts in an animal model. Conclusion: This article provides possibilities for training, creating grafts, and developing rhinoplasty techniques with the chicken breast cartilage. The creative template application shows an objective, clear, and systematic manner of learning without fear the beauty of the rhinoplasty art. This study is specially designed for young surgeons with a very low cost, artistry, and a reproducible way. No competing financial interests exist. No funding was received for this article. Runtime of video: 6 mins 44 secs

Rhinoplasty: Considerations for Patients with Facial Paralysis.

Nasal obstruction is a common sequela of flaccid facial paralysis but one that is often underaddressed surgically. Weakness of nasal musculature on the paralyzed side of the face leads to nasal valve narrowing through loss of static and dynamic nasal side wall tone as well as inferomedial displacement of the alar base. Standard rhinoplasty techniques such as alar batten grafts or flaring sutures may be used to support the nasal side wall in facial paralysis. However, to address the inferomedial alar displacement, suspension techniques are often required. Suture resuspension and fascia lata resuspension techniques are described, with modifications to each to improve longevity of the suspension.

The Transoral Alar Batten Graft: A Functional Rhinoplasty Technique for the Orthognathic Jaw Surgery Patient.

Many patients seeking orthognathic jaw surgery also experience nasal obstruction. Current transoral functional rhinoplasty techniques include septoplasty and inferior turbinate reduction, which are performed through the mouth after maxillary downfracture. Although powerful, these interventions do not treat dynamic nasal sidewall collapse. The authors describe a novel transoral alar batten graft. Using the maxillary vestibular approach, septal cartilage is harvested and delivered from the maxillary vestibule into the nasal alar-sidewall junction through a small tunnel. This procedure is simple and versatile, and carries minimal morbidity, enabling the orthognathic jaw surgeon to support the nasal sidewall through a minimal-access approach and improve the patient's nasal function and airway.

Efficacy of extended alar batten graft with Tajima reverse U incision for unilateral cleft rhinoplasty: a case control study

article: Efficacy of extended alar batten graft with Tajima reverse U incision for unilateral cleft rhinoplasty: a case control study - Otorhinolaryngology 2022 June;72(2):79-83 - Minerva Medica - Journals

Modified alar batten grafts for treatment in nasal valve dysfunction: Our experience

ObjectiveAlar batten grafts are used to treat in nasal valve dysfunction (NVD). They can be placed by open or closed rhinoplasty using rib, septal, or auricular concha cartilage. Our surgical team used a modified placement of the classic alar batten.We aim to describe these changes and to the technique and demonstrate that modified alar batten grafts can improve the effects of spreader grafts and classic alar batten grafts. MethodsA retrospective study of 91 functional rhinoplasties was performed from March 2011 to November 2019 at a public university hospital in Murcia. The patients were divided into three groups. Group A included patients operated on using spreader grafts, group B included patients operated on using spreader grafts associated with alar batten grafts fixed to the caudal edge of the lateral crura of the lower lateral cartilage (LLC), and group C included patients operated on using modified alar batten grafts. ResultsA total of 91 functional rhinoplasties were performed, 31 patients were operated on in group A, 27 patients were operated on in group B, and 33 patients were operated on in group C. The success rate was 67.7% in group A, 70.4% in group B and 93.9% in group C. ConclusionModified alar batten grafts achieved better results than spreader grafts and spreader grafts associated with classic alar batten grafts. The size, position and placement of the sutures of modified alar batten grafts were the key factors in improving our results.

Surgical Management of the Internal Nasal Valve: A Review of Surgical Approaches.

Nasal valve collapse is relatively common with a lifetime prevalence of up to 13%. Etiologies include prior rhinoplasty, other surgical procedures, facial paralysis, congenital defects, trauma, and aging. Internal nasal valve collapse leads to impairment of nasal breathing, which significantly disturbs quality of life. Many approaches to increase the cross-sectional area of the internal nasal valve have been described. The main categories reviewed in this article are cartilage grafting, implants, and suture suspension techniques. Cartilage grafting techniques include alar batten graft, butterfly graft, spreader graft, autospreader graft, and alar composite graft. The implant technique includes the titanium butterfly implant. The suspension techniques included are the transconjunctival approach, Mitek bone anchor, flaring suture, lateral pull-up, and piriform rim suspension. Surgeons must carefully consider functionality, cosmesis, and technical difficulty when selecting an approach. We review indications, general approach, benefits, and considerations for a number of available techniques to help surgeons decide what approach might be best suited to the individual patient. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Literature scans: cartilage grafts in nasal tip rhinoplasty

In the last years, surgical strategies in rhinoplasty were deeply modified with a gradual shifting from a reductive rhinoplasty, with aggressive intervention and trimming of the cartilages, to a more conservative and then “additive” rhinoplasty. We aimed to report the different types of autologous cartilage graft and the specific indications for each one. The authors reviewed 201 papers published in the last 10 years in the international literature database PUBMED and EMBASE deciding to isolate only those articles providing either retrospective or prospective data pertaining to outcomes, descriptions, and complications of the cartilage grafts use in nasal tip’s rhinoplasty. Of the 201 articles, 96 were initially selected. Of these, 38 met the predetermined criteria for inclusion. Nasal septum, concha, and the ribs are the main sources for autografts to be used in rhinoplasty. Septal cartilage is easy to harvest, it is versatile, could be useful for many types of grafts, and it has a low percentage of resorption, extrusion, and warping. Cartilage from the auricular concha can be used to correct both the internal and external nasal valve collapse with satisfactory results. Costal chondral grafts are usually used for structural support when septal cartilage is not available. It is possible to divide autologous grafts into two main categories: structural grafts (columellar strut, septal extension, and the alar batten grafts) and contour improving grafts (onlay tip, shield, cap, and the alar rim grafts) useful for the structural support to the tip and smoothing and hiding irregularities. Level of Evidence: Not ratable.

Lower lateral crural turnover flap combined with alar batten graft for the long-term result of the treatment of alar convexities.

Introduction:Concave lower lateral cartilages not only cause an esthetic defect but can also lead to external nasal valve insufficiency. The objective of this article is to analyze the combination of two well-known surgical techniques: turning over the alar cartilages as well as the addition of grafts in order to obtain satisfying esthetic and functional long term results.Materials and methods:From August 2016 to July 2018, 62 rhinoplasties, a combination of both primary and revision cases, were performed at the Rouen University Hospital in France. Six of these involved the correction of concave alar cartilages. The turnover technique alone or in combination with Batten grafts was performed.Results:Immediate and 3-months post-operative esthetic results using the turnover flap technique were satisfactory. Alar batten grafts were occasionally employed in order to maintain the newly positioned alar cartilages and avoid long-term contour depressions.Conclusion:The combination of these two techniques seems to be an interesting solution to maintain long-term esthetic results.

External Nasal Valve Repair in Children: Alar Batten Graft Reinforced by External Temporary Suspensory Suture.

The nasal valve area is the narrowest point in the nasal airway. External nasal valve (ENV) collapse during inspiration occurs if external valve area is too narrow or its lateral component is too floppy. Twelve patients (7 males, 5 females) aged 8 to 12 years complaining of nasal obstruction due to ENV dysfunction underwent surgical intervention using alar batten graft assisted by temporary external suspensory suture. All patients showed subjective and objective improvement of the nasal airway. The mean Nasal Obstructive Symptom Evaluation (NOSE) was 14 ± 1.71 before surgery and 7.83 ± 1.47 1 year after surgery (significant improvement, p ≤ .0001). The mean Peak Inspiratory Flow Rate was 29.92 ± 4.46 before surgery and 42.58 ± 4.93 1 year after surgery (significant improvement, P ≤ .0001). External nasal valve collapse in children can be managed surgically by using alar batten graft. Temporary suspension suture can be helpful for supporting of the graft until complete healing occurs.

L-Shaped Septal Extension Spreader Graft for Improvement of Tip Symmetry in Unilateral Cleft Lip Nose Deformities.

The unilateral cleft lip nose is characterized by numerous complex and interdependent deformities. Secondary rhinoplasty techniques aim to correct cleft lip nose deformities by using multiple maneuvers combining septum and nasal spine medialization and alar cartilage, as well as soft tissue mobilization and repositioning. Moreover, cartilage grafting is frequently used to restore adequate tip projection and nasal symmetry. We present a technique of cartilage grafting commonly used in noncleft rhinoplasties that we modified for cases of moderate cleft lip nose deformities. We present a retrospective case study of 21 patients with moderate unilateral cleft lip nose deformities who underwent secondary septorhinoplasty with an L-shaped septal extension spreader graft combined with alar rim, alar batten graft, and soft tissue repositioning. Exclusion criteria were severe or complex septal deviation avoiding a stable fixation of the graft. Mean follow-up time was 28 months. Surgical outcomes were analyzed by anthropometric measurements of standardized preoperative and postoperative photographs. All parameters improved except for the nostril height. The height between the alar base and the dome defining dome symmetry, as well as the angles between the lower lateral cartilage and the alar base (α) defining the orientation of the alar rim, improved significantly. The mean ratios of cleft/noncleft side of the height between the alar base and the dome and α showed statistically significant improvements from 0.833 (preoperative) to 0.994 (postoperative) (P < 0.0001) and from 0.883 to 1.02 (P = 0.0038), respectively. The L-shaped septal extension spreader graft combined with alar batten graft and soft tissue repositioning is an option for secondary rhinoplasties in unilateral cleft lip nose deformities minimizing tip rigidity with significant improvement of the dome's height and its symmetry, as well as the alar side angle.

Surgical Correction of Alar Collapse with Alar Batten Graft : Technique and Results

Background: nasal valve collapse has great perception of nasal obstruction. The alar batten graft technique has proven to be a valid method for treatment of external and internal valve collapse. Aim: the aim of the present study was to evaluate a two year experience and follow up for external nasal valve collapse treatment using alar batten graft technique regarding results and complications. Patients and Methods: this prospective study was carried out on 18 patients attended the ENT and Plastic Surgery outpatient clinics of Al-Azhar University hospitals from January, 2014 to January 2016. Written consent was taken from every patient. All patients were complaining of nasal obstruction of gradual onset and progressive course with 7 years average. All patients were subjected to detailed history taking and questionnaire including the NOSE scale. Surgical correction was performed to all patients using the alar batten graft harvested from the septa cartilage or conchal cartilage. Postoperative results recorded in relation to subjective sensation of nasal obstruction and aesthetic appearance of the nose. Results: eleven patients (61.1%) were males and seven (38.9%) were females. Their age ranged from 18 to 45 years with a mean of 32±2. Bilateral obstruction was found in 33.3% of cases and unilateral obstruction in 66.7% of cases. There were 22.2%, 27.8%, and 50.0% of the cases had moderate, fair, and severe obstruction, respectively. Postoperatively, these figures were changed to no obstruction77.8% (P=0.0), mild 0.0%, moderate 11.1%, fair 11.1%, and sever 0.0%(P=0.0005). The technique significantly abolishes the severe nasal obstruction. Postoperative complications include 1 case with graft resorption (4.2%) and 1 case of graft displacement (4.2%). Both were improved on subsequent surgery. Regarding postoperative findings there was tenderness and hypertrophic postauricular scar in 5.5% of patient and nasal tip edema in 22.2%, all resolved. In the early postoperative period, 33.3% of patients complained of fullness in the supraalar region. Conclusion: Successful surgical correction of nasal obstruction requires the precise diagnosis of the anatomic point of collapse. Alar batten graft improves the rigidity of lower lateral cartilage preventing collapse of the lateral nasal wall preventing collapse during moderate and deep inspiration. The graft varies according to the severity of the obstruction and size of the collapsible area of the lateral nasal wall. The septal cartilage is usually sufficient. The technique significantly improves nasal breathing.

Posttraumatic Nasal Valve Collapse: Is Alar Batten Graft the Answer?

ABSTRACT Introduction Posttraumatic nasal valve collapse (NVC) is an underdiagnosed cause of nasal obstruction causing significant symptoms and has been treated by various techniques, the results of which have been variable. In our study, alar batten graft (ABG) has been used to strengthen the nasal wall. Techniques A prospective interventional study was done on 13 patients of posttraumatic NVC using an ABG to reinforce the ala, and results were measured on the basis of standardized nasal obstruction symptom evaluation (NOSE) and nasal obstruction visual analog scale (NO-VAS) scores at 6 months. Results There was a statistically significant improvement in 12 out of 13 patients, with mean improvement of 25.62 on NOSE and 2.4 on NO-VAS scores. There was a visible improvement in the extent of collapse also. Conclusion Posttraumatic NVC can be treated effectively using ABG, with significant improvement in standard scores as well as the symptomatology. How to cite this article Maggon NV, Sethi A, Das A. Posttraumatic Nasal Valve Collapse: Is Alar Batten Graft the Answer? Clin Rhinol An Int J 2016;9(3):125-129.

Correction of severe alar retraction with alar rotation flap

To investigate the therapeutic effect of alar rotation flap for severe alar retraction. Patients with severely retracted alar underwent ala reconstruction using alar rotation flaps and autogenous cartilage batten grafts. First, costal cartilage was used to reshape the nasal tip and nasal dorsum. Then cartilage patch was used to extend and thicken the retracted alar. Then the alar rotation flap was transferred to correct retracted alar. Fourteen patients with severe alar retraction underwent alar reconstruction with alar rotation flap and alar batten grafts. The alar retraction was corrected in all cases, with improvements functionally and aesthetically. No recurrence of alar retraction was noted. The incision healed with acceptable cosmetic results, with obvious scar in only one patient (one side). The alar rotation flap is an effective and reliable surgical option to correct severe alar retraction. Scar can be kept inconspicuous by precise placement of the incision within the junction of the ala and the nasal dorsum, following principles of the aesthetic nasal subunits.

Alar Retraction

The effect of different rhinoplasty maneuvers on alar retraction remains to be elucidated. To determine the etiology and treatment of alar retraction based on a series of specific rhinoplasty maneuvers. Retrospective review of a single surgeon's rhinoplasty digital photo database, examining preoperative alar retraction from January 1, 2002, to December 31, 2005, in 520 patients. Patients with more than 1 mm of alar retraction on preoperative photographs were identified. Postoperative photographs were examined to determine the effect of specific rhinoplasty maneuvers on the position of the alar margin; these maneuvers included cephalic trim, cephalic positioning of the lower lateral cartilage, composite grafts, alar rim grafts, alar batten grafts, and overlay of the lower lateral cartilage. Tertiary care academic health center. Forty-five patients with alar retraction met inclusion criteria, resulting in 63 nasal halves with alar retraction. Intraoperative findings, postoperative results. Forty-seven percent of the patients (n = 21) had prior surgery; 47% also had cephalically positioned lower lateral cartilages. Among patients with less than 4 mm of cartilage width at the outset, 46% of those who received supportive grafts achieved target correction vs only 7% for patients who did not undergo supportive cartilage grafting. In patients who underwent more than 4 mm of cephalic trim, those who received supportive grafts achieved 46% of target correction vs 11% among those who did not. Ninety-five percent of composite grafts, 69% of alar strut grafts, 47% of alar rim grafts, 43% of vertical lobule division, and 12% of alar batten grafts achieved their target correction values. Alar retraction is a highly complex problem. It can be seen de novo and is associated with cephalically positioned lower lateral cartilages. Structurally supportive grafting-including composite grafts, alar strut grafts, alar rim grafts, vertical lobule division, and alar batten grafts-can improve alar retraction. 4.

The Effects of Alar Batten Grafts on Nasal Airway Obstruction and Nasal Steroid Use in Patients With Nasal Valve Collapse and Nasal Allergic Symptoms

Clinical management of nasal airway obstruction (NAO) in patients with and without nasal allergic symptoms and nasal valve collapse (NVC). To examine the impact that autologous alar batten grafts have on patients with NAO owing to NVC and their affect on nasal steroid use and allergic symptoms. A prospective study. Indiana University Medical Center, Indianapolis. Patients with NAO due to NVC with or without symptoms of nasal allergic symptoms. All of the patients had placement of autologous batten grafts during the study period. Prospective study of patients with dynamic NVC undergoing alar batten graft treatment. Nasal Obstruction Symptom Evaluation survey preoperatively and postoperatively, prospective outpatient questionnaire to determine use of nasal steroids and presence of nasal allergic symptoms preoperatively and postoperatively. A total of 126 patients underwent surgical intervention for the treatment of NAO due to NVC. All of these patients were using nasal steroid sprays, and 78 patients (62%) also reported nasal allergic symptoms at their initial presentation. At 6-month and 1-year postoperative evaluations, 118 (94%) and 122 (97%), respectively, reported significant improvement of their NAO, regardless if they had presented with or without allergic nasal symptoms. Sixty-two of the 78 patients (79%) who initially presented with NAO owing to NVC and nasal allergic symptoms preoperatively reported significant improvement in their NAO and nasal allergic symptoms postoperatively. Eight of 126 (6%) restarted their use of nasal steroids postoperatively. All 8 of these patients reported nasal allergic symptoms preoperatively. No patients in the nonallergic group continued the use of nasal steroids postoperatively. There was no increase in nasal steroid use at the 12-month follow-up visit. Nasal airway obstruction due to NVC in patients can be surgically treated with autologous alar batten grafts. In addition, the use of alar batten grafts may improve NAO in patients with nasal allergic symptoms and reduces their use of nasal steroids. These results support the idea of potential surgical repair of the nasal valve to treat patients with NAO due to nasal allergic symptoms and NVC. 4.

The Oblique Split Method

Autogenous rib cartilage is widely used in the septorhinoplasty cases with major structural grafting requirements. However, there is a risk of warping over time. To introduce a novel method for carving costal cartilage grafts to obtain straight grafts of varying thicknesses and to eliminate the risk of warping. Between 2007 and 2011, a total of 43 consecutive patients underwent septorhinoplasty using autogenous costal cartilage grafts carved by the oblique split method (OSM). The Ankara Training and Research Referral Hospital, Ankara, Turkey. The study included 43 patients with saddle nose deformity and revisional rhinoplasty with a depleted source. All patients were followed-up for a period ranging from 12 to 37 months (mean, 19.2 months) after surgery. All patients underwent open or closed septorhinoplasty. Autogenous costal cartilage was carved with the OSM to obtain grafts suitable for use as columellar strut, dorsal onlay, L-strut, lateral crural strut, caudal extension, and tip or speader grafts in selected cases. Patients were evaluated by inspection, palpation, and photographic documentation before surgery. Inspection, palpation, and photographic documentation were carried out every 6 months and 12 months after surgery and once a year thereafter. Patient satisfaction in terms of form and function was achieved in 41 patients (95%). Two patients required reoperation for further tip projection (n=1) and alar batten graft displacement (n=1). No complication was observed as a result of graft warping, resorption, or fracture. The OSM provides straight costal cartilage grafts of varying thicknesses without the risk of warping. Because they strictly preserve their straight form, the grafts may safely be modified into rectangular shape or carved asymmetrically and/or have their edges beveled. Current data from this study suggest that the OSM offers a flexible and reliable reconstructive option for the rhinoplasty surgeon. 4.

Rhinoplasty

Rhinoplasty

Internal Nasal Valve Incompetence Is Effectively Treated Using Batten Graft Functional Rhinoplasty

Introduction. Internal nasal valve incompetence (INVI) has been treated with various surgical methods. Large, single surgeon case series are lacking, meaning that the evidence supporting a particular technique has been deficient. We present a case series using alar batten grafts to reconstruct the internal nasal valve, all performed by the senior author. Methods. Over a 7-year period, 107 patients with nasal obstruction caused by INVI underwent alar batten grafting. Preoperative assessment included the use of nasal strips to evaluate symptom improvement. Visual analogue scale (VAS) assessment of nasal blockage (NB) and quality of life (QOL) both pre- and postoperatively were performed and analysed with the Wilcoxon signed rank test. Results. Sixty-seven patients responded to both pre- and postoperative questionnaires. Ninety-one percent reported an improvement in NB and 88% an improvement in QOL. The greatest improvement was seen at 6 months (median VAS 15 mm and 88 mm resp., with a P value of <0.05 for both). Nasal strips were used preoperatively and are a useful tool in predicting patient operative success in both NB and QOL (odds ratio 2.15 and 2.58, resp.). Conclusions. Alar batten graft insertion as a single technique is a valid technique in treating INVI and produces good outcomes.