Alar Batten Grafts Research Articles

Use of alar batten grafts for correction of nasal valve collapse.

To determine the efficacy of alar batten grafts for the correction of internal and external nasal valve collapse. In this retrospective study, a questionnaire was used to ask patients to rate their nasal breathing before and after application of alar batten grafts. Private practice and academic tertiary referral medical center. The questionnaire was given to 63 patients who underwent application of alar batten grafts between 1980 and 1995. Forty-six patients (73%) responded and were included in the study. Alar batten grafts were applied into a precise pocket via a limited endonasal incision or via the external rhinoplasty approach. The grafts consisted of curved septal cartilage or auricular cartilage and were applied to the site of maximal lateral nasal wall collapse. The convex surface of the cartilage was oriented laterally to allow maximal lateralization of the collapsed portion of the lateral nasal wall. In most cases, alar batten grafts were applied caudal to the existing lateral crura and extended from the lateral one third of the lateral crura to the piriform aperture. The degree of nasal airway obstruction was determined by subjective scoring on a scale from 1 (no obstruction) to 5 (complete obstruction) before and after surgery. The patency of the internal airway was also assessed on physical examination. The results of the study revealed that all but 1 of the 46 patients experienced an improvement in their nasal airway obstruction. The mean improvement in nasal airway obstruction was 2.5 on a scale of 5. Patients that had the least improvement had intranasal scarring in the region of the internal nasal valve, loss of vestibular skin, or excessive narrowing at the piriform aperture. Physical examination revealed a significant increase in the size of the aperture at the internal or external nasal valve after the application of the alar batten grafts. There was minimal postoperative fullness in the supraalar region, where the alar batten grafts were applied. With time, this fullness decreased, leaving little evidence of the graft and an overall improvement in the aesthetic result. Alar batten grafts are effective for long-term correction of internal and external nasal valve collapse that is not complicated by intranasal scarring in the region of the nasal valve, loss of vestibular skin, or excessive narrowing at the piriform aperture.

Management of the middle nasal vault in rhinoplasty

The incidence of aesthetic and functional complications of rhinoplasty can be decreased by preserving supportstructures of the nose. This is particularly important in patients at high risk for collapse of the middle nasal vault (cartilaginous nasal vault). Aggressive surgical manipulation of the upper lateral cartilages can result in excessive narrowing of the middle vault and collapse of the internal nasal valve. Spreader grafts can be used to provide appropriate width to the middle vault and preserve nasal valve function. This paper will discuss indications and technique for application of spreader grafts using the open rhinoplasty approach. Spreader grafts can be used in high risk patients with short nasal bones, long weak upper lateral cartilages, thin skin, and narrow projecting nasal vault. These patients are at higher risk for excessive narrowing of the middle vault (inferomedial collapse of upper lateral cartilages) because of loss of medial support after hump removal. Spreader grafts will support the lateral nasal wall, preserve nasal width, and prevent deformity. Spreader grafts can also be used to add width to the cartilaginous vault in disproportioned noses that have an excessively narrow middle vault and broad nasal tip. This maneuver will allow the surgeon to perform conservative narrowing of the nasal tip and prevent deformity or compromise of nasal function. Spreader grafts can be used in combination with lateral crural grafts or alar batten grafts to correct secondary deformities of the internal and/or external nasal valve. Conservative reduction and thoughtful augmentation in rhinoplasty will preserve nasal support and function with improved long-term results.