Private Clinic, Izmir, Turkey.
Adana Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, University of Health Sciences, Health Application and Research Center, Adana, Turkey.
Aesthetic Plast Surg. 2022 Oct;46(5):2413-2427. doi: 10.1007/s00266-021-02632-6. Epub 2021 Nov 1.
The internal nasal valve is one of the highly important anatomical points in rhinoplasty procedures. As a key anatomical area, the anatomical and functional integrity of this region must be preserved or reconstructed during rhinoplasty procedures. Several techniques have been defined in the literature for midvault restoration, among which, the most common are spreader grafts and flaps. Both techniques achieve a natural and harmonic contour but may fail to provide the splay effect to the upper lateral cartilages in some cases. A new technique known as the "T-splay graft", to be used as an alternative approach in cases where there is a risk of midvault collapse, and in which the splay effect in the upper lateral cartilage is preferred to be augmented, is explained in the present study.
In the present study, a septal tunnel is opened of sufficient size for the cartilage graft planned for placement, at the planned level of the septum, to expand the midvault region and create a splay effect. A bilateral pocket is created in the inferior mucosa of the upper lateral cartilages. The harvested cartilage graft is passed through the septum in the horizontal plane. The cartilage graft is inserted into the bilateral pockets so as way to create convexity to the dorsum.
As a result of the applied method, it was established that the internal nasal valve angle could be expanded to the desired extent and the dorsal aesthetic lines could be achieved in a normal anatomical structure.
This technique enables the lateral direction of the tension between the graft and the upper lateral cartilages, and the creation of a splay effect. As such, we believe that this method is a highly effective alternative for use in appropriate cases.
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鼻内阀是鼻整形术中非常重要的解剖学要点之一。作为一个关键的解剖区域，该区域的解剖和功能完整性必须在鼻整形术中得以保留或重建。文献中已经定义了几种中隔穹窿修复技术，其中最常见的是鼻中隔扩张器移植物和皮瓣。这两种技术都能达到自然和谐的轮廓，但在某些情况下可能无法为上外侧软骨提供外展效果。本文介绍了一种新的技术，称为“T 型外展移植物”，用于中隔穹窿有塌陷风险的病例，或者更倾向于增加上外侧软骨外展效果的病例，可作为替代方法。
在本研究中，在计划放置软骨移植物的鼻中隔水平，打开一个足够大小的鼻中隔隧道，以扩大中隔穹窿区域并产生外展效果。在上外侧软骨的下鼻甲黏膜中创建双侧口袋。通过鼻中隔在水平平面上传递移植物。将移植物插入双侧口袋中，使背侧呈凸形。
应用该方法可将鼻内阀角度扩展到所需的程度，并在正常解剖结构中实现背侧美学线。
该技术可使移植物和上外侧软骨之间的张力向外侧方向，从而产生外展效果。因此，我们认为这种方法是一种在适当情况下非常有效的替代方法。
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