Use of the spring graft for prevention of midvault complications in rhinoplasty.

BACKGROUND

Preservation of the middle nasal vault has increasingly become a topic of interest and concern in rhinoplasty. Resection of even a minute amount of roof during hump removal disturbs the stabilizing effect of the upper lateral cartilages, which then causes a fall of upper lateral cartilages medially toward the anterior septal edge, restricting airflow at the internal valves and creating midvault problems.

METHODS

The resected alar cartilages were placed deep to the upper lateral cartilages as a strengthened spring to prevent midvault collapse and internal valve incompetency. Although weak and small alar cartilages are limitations of the technique, the authors think that this is not so frequent because the total force exerted on the upper lateral cartilages by the spring graft is higher than the force of each individual two cartilage pieces.

RESULTS

It was easy to view the widening of the internal valve and the smooth appearance of the middle third of the nose intraoperatively. All patients were satisfied with the results both functionally and aesthetically.

CONCLUSIONS

The spring graft technique, a modification of the splay graft, handles both the functional and aesthetic problems in the dorsal midvault. The spring graft, with its advantages and disadvantages, is a technique that solves the frequently encountered problems of incompetent internal nasal valve and midvault collapse without the need for a second donor site. It is a simple, reliable technique that is easy to learn and execute and must be kept in mind in selected patients.