Upper Lateral Splay Graft

Abstract

Middle vault collapse narrows the internal nasal valve and impairs airflow through the nose. Loss of structural integrity of the upper lateral cartilaginous vault, the cause of the middle vault collapse, is classically corrected by inserting anterior spreader grafts, resulting in variable success. The desire to reconstruct the natural "T" of the upper lateral and septal cartilages culminated in the development of the upper lateral splay graft. The splay graft spans the dorsal septum but is deep to the left and right upper lateral cartilages. The intrinsic spring in the splay graft elevates each upper lateral cartilage with the septum as the fulcrum, thus correcting the middle vault collapse and opening the internal valve. The procedure, a physiologic substitute for the device "Breathe Right" applied externally, has been performed on nine patients and proved to be a prodigious functional boon to all of them. The powerful splay effect, however, can result in excessive widening of the caudal portion of the dorsum with imprudent use of the technique. Two case reports illustrate the subjective and objective improvement that was shared in all but one patient. Excess widening in one patient resulted in a suboptimal aesthetic improvement, although the functional objectives were met. Identification of suitable patients, preoperative assessment, choice of cartilage donor site, and the surgical technique are discussed. Improved internal valve function, predictability, and reliability are some of the distinct advantages of using a splay graft.

Anatomical Variations of the Upper Lateral Cartilages and Their Implications in Rhinoplasty

“…These findings provide a basis for the suggestion that spreader grafts must range from 11 to 27 mm in length during rhinoplasty. The findings of the present study still agree with those of other studies which suggest the restoration of the anatomy by sutures between the upper lateral cartilages and the dorsal septum, using spreader grafts or flaps, which would favor the healing of these cartilages in proper position [20][21][22].…”

Tiers moyen du nez et valve interne. Paroi alaire et valve externe

“…En cas de destruction importante des cartilages triangulaires, une greffe de conque placée à cheval sur le tiers moyen et s'étendant latéralement entre les bords antérieurs des cartilages triangulaires (déficients ou précédemment réséqués) et la muqueuse permet d'améliorer la forme et la fonction (« splay graft ») [19,20] (Fig. 13).…”

A Patient With Nasal Valve Compromise

“…These include the "autospreader flap," 11 which uses the excess width of the ULC following dorsal hump removal as a turn-in flap, and the "butterfly" 2 and "splay" 12 grafts, each of which uses a conchal cartilage graft to support the caudal ULC.…”