The “Butterfly Graft” as a Treatment for Internal Nasal Valve Incompetence

André, Robert; Vuyk, H. D.

doi:10.1097/prs.0b013e31817d60cc

Cited by 12 publications

(20 citation statements)

References 2 publications

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“…To our knowledge, this study represents the largest group of patients undergoing the butterfly graft reported in the medical literature. Our findings confirm the previously reported efficacy of the butterfly graft in relief of NAO in both primary and secondary rhinoplasty patients . Although not the focus of this study, in addition to contributing to a general sense of well‐being, patients frequently report dramatic improvement in exercise tolerance and sleep hygiene.…”

Section: Discussionsupporting

confidence: 90%

“…Technical modifications have included: 1) universal incorporation of the postauricular surface perichondrium with the graft, 2) meticulous carving of the cartilaginous portion of the graft with beveling of the edges, 3) customized shape and size of the graft but a trend toward smaller size, 4) universal release of the ULCs from the dorsal septum, and 5) in situ reduction of the lateral graft wings. These technical changes have allowed for an expansion in the utilization of butterfly graft to a broader group of patients, who would not have otherwise had the opportunity for the superlative functional results implicit with the butterfly graft . Despite extending patient selection, our results show that the patient‐reported aesthetic results remain favorable, and the functional outcomes remain constant.…”

Section: Discussionmentioning

confidence: 83%

“…However, as has been previously noted, the technique for design and placement of spreader grafts must be meticulous to avoid inadvertent narrowing of the apex of the nasal valve (Fig. ) …”

Section: Discussionmentioning

confidence: 99%

“…4). [14][15][16][17][18][19]43,44 Technically, we believe that the meticulous beveling, or scalloping, of the cephalic and lateral margins of the cartilage portion of the graft (Fig. 1) lead to improvement in patient-reported aesthetic outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…They are routinely placed by many rhinoplasty surgeons to prevent postoperative development of NVC, but this approach has been questioned . The butterfly graft was first introduced as an alternative to the spreader graft in secondary rhinoplasty by Clark and Cook and has gained popularity in addressing internal nasal valve (INV) compromise in both primary and secondary rhinoplasties . This onlay graft fabricated from conchal cartilage is placed superficial to the caudal septum through either a closed or open approach and is sutured to the caudal margins of the underlying upper lateral cartilage (ULC), providing a more obtuse superior INV angle.…”

Section: Introductionmentioning

confidence: 99%

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Evolution of the butterfly graft technique: 15‐year review of 500 cases with expanding indications

Howard

Clark

2019

The Laryngoscope

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Objectives/Hypothesis To describe the evolution of the butterfly graft technique for the treatment of nasal valve compromise, with specific attention to technical developments allowing for expanded indications. To review the impact on patient‐reported outcomes of nasal airway function and nasal aesthetics. Study Design Retrospective chart review. Methods A review of a single surgeon's patients at a private practice and tertiary care center undergoing surgical correction for nasal valve compromise using the butterfly graft technique between July 2002 and April 2017. Data collected included etiology of nasal valve compromise, additional procedures performed, complications, and functional and aesthetic patient‐reported outcomes. Results Over the study period, 512 patients underwent surgery to correct nasal valve compromise utilizing the butterfly graft technique. The overall patient‐reported relief of nasal obstructive symptoms was complete in 87%, improved but not completely relieved in 10%, and not improved in 4%. No patients reported a worsening in their nasal obstructive symptoms. The overall patient‐reported change in nasal appearance was improved 53%, the same 32%, worse in 15%. The patients in the latter half of the study tended to report better aesthetic results. Conclusions The results of this study suggest that the surgical technique for the butterfly graft evolved over time and allowed for improved aesthetic outcomes, without reduction in the efficacy in correction of nasal valve compromise. The evolution in technique allowed for expansion of the indications for the butterfly graft while maintaining the favorable patient‐reported aesthetic and functional results. Level of Evidence 4 Laryngoscope, 129:S1‐S10, 2019

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 83%

“…However, as has been previously noted, the technique for design and placement of spreader grafts must be meticulous to avoid inadvertent narrowing of the apex of the nasal valve (Fig. ) …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evolution of the butterfly graft technique: 15‐year review of 500 cases with expanding indications

Howard

Clark

2019

The Laryngoscope

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Modifications to the Butterfly Graft Used to Treat Nasal Obstruction and Assessment of Visibility

Loyo

Gerecci

Mace

et al. 2016

JAMA Facial Plast Surg

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IMPORTANCEGraft visibility in the supratip region has been the main criticism of the butterfly graft. Because of the graft location, slightly unfavorable supratip fullness can occur, resulting in patient dissatisfaction with the cosmetic result.OBJECTIVE To describe the clinical outcomes and visibility of the butterfly graft after technique modifications. DESIGN, SETTING, AND PARTICIPANTSIn this retrospective review of adults who had undergone primary or secondary rhinoplasty with butterfly grafting from July 1, 2013, through July 31, 2014, at a tertiary care center at an academic institution, an operative log and photographs were reviewed in an effort to analyze outcomes of butterfly graft use in rhinoplasty. MAIN OUTCOMES AND MEASURES Nasal obstruction and visibility of the butterfly graft.RESULTS Thirty-four patients were included in the case series (mean [SD] age, 46 [19.4] years; 23 women and 11 men). The mean (SD) length of the graft was 3.4 (0.5) cm, and the mean (SD) width was 0.9 (0.2) cm. A significant decrease was found in the Nasal Obstruction Symptoms Evaluation score after surgery (mean [SD] preoperative score, 69 [17]; mean [SD] postoperative score, 23 [24]; P < .001). In regard to appearance, 25 patients (74%) rated their appearance as improved or no changes, 6 (18%) as minimally worse, and 1 (3%) as much worse. Fifty-nine observers participated in the masked survey for the study. When the graft was present, observers detected it 59.7% (282 of 472 answers) of the time. When the graft was not present, its presence was suspected 36.5% (237 of 649 answers) of the time. CONCLUSIONS AND RELEVANCEThe modified butterfly graft is a longer and thinner graft than the originally described butterfly graft. It is still an effective tool in the treatment of nasal obstruction with acceptable visibility. In most cases, it is difficult for health care professionals to identify the presence of the graft.LEVEL OF EVIDENCE 4.

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Virtual Surgery for the Nasal Airway

Vanhille

Garcia

Asan

et al. 2018

JAMA Facial Plast Surg

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IMPORTANCE Nasal airway obstruction (NAO) is a common problem that affects patient quality of life. Surgical success for NAO correction is variable. Virtual surgery planning via computational fluid dynamics (CFD) has the potential to improve the success rates of NAO surgery.OBJECTIVE To elicit surgeon feedback of a virtual surgery planning tool for NAO and to determine if this tool affects surgeon decision making. DESIGN, SETTING, AND PARTICIPANTSFor this cross-sectional study, 60-minute face-to-face interviews with board-certified otolaryngologists were conducted at a single academic otolaryngology department from September 16, 2016, through October 7, 2016. Virtual surgery methods were introduced, and surgeons were able to interact with the virtual surgery planning tool interface. Surgeons were provided with a patient case of NAO, and open feedback of the platform was obtained, with emphasis on surgical decision making. MAIN OUTCOMES AND MEASURESLikert scale responses and qualitative feedback were collected for the virtual surgery planning tool and its influence on surgeon decision making.RESULTS Our 9 study participants were all male, board-certified otolaryngologists with a mean (range) 15 (4-28) number of years in practice and a mean (range) number of nasal surgeries per month at 2.2 (0.0-6.0). When examined on a scale of 1 (not at all) to 5 (completely), surgeon mean (SD) score was 3.4 (0.5) for how realistic the virtual models were compared with actual surgery. On the same scale, when asked how much the virtual surgery planning tool changed surgeon decision making, mean (SD) score was 2.6 (1.6). On a scale of 1 (strongly disagree) to 7 (strongly agree), surgeon scores for perceived usefulness of the technology and attitude toward using it were 5.1 (1.1) and 5.7 (0.9), respectively. CONCLUSIONS AND RELEVANCEOur study shows positive surgeon experience with a virtual surgery planning tool for NAO based on CFD simulations. Surgeons felt that future applications and areas of study of the virtual surgery planning tool include its potential role for patient counseling, selecting appropriate surgical candidates, and identifying which anatomical structures should be targeted for surgical correction.LEVEL OF EVIDENCE NA.

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The “Butterfly Graft” as a Treatment for Internal Nasal Valve Incompetence

Cited by 12 publications

References 2 publications

Evolution of the butterfly graft technique: 15‐year review of 500 cases with expanding indications

Evolution of the butterfly graft technique: 15‐year review of 500 cases with expanding indications

Modifications to the Butterfly Graft Used to Treat Nasal Obstruction and Assessment of Visibility

Virtual Surgery for the Nasal Airway

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