Guyuron B, Michelow B J, Englebardt C
Case Western Reserve University Cleveland, Ohio, USA.
Plast Reconstr Surg. 1998 Nov;102(6):2169-77. doi: 10.1097/00006534-199811000-00058.
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.
中鼻拱塌陷会使鼻内瓣膜变窄并损害鼻腔气流。上外侧软骨拱的结构完整性丧失是中鼻拱塌陷的原因，传统上通过插入前撑开移植物来矫正，但成功率各异。重建上外侧软骨和鼻中隔软骨自然“T”形的愿望最终促成了上外侧撑开移植物的发展。撑开移植物横跨鼻中隔背侧，但位于左右上外侧软骨的深部。撑开移植物的固有弹性以鼻中隔为支点抬高每个上外侧软骨，从而矫正中鼻拱塌陷并打开鼻内瓣膜。该手术是外部应用的“呼吸易”装置的生理替代方法，已在9名患者身上实施，对所有患者均证明有巨大的功能益处。然而，若技术使用不当，强大的撑开效果可能导致鼻背尾部过度增宽。两篇病例报告说明了除一名患者外所有患者都有的主观和客观改善情况。一名患者的过度增宽导致美学改善欠佳，尽管达到了功能目标。文中讨论了合适患者的识别、术前评估、软骨供体部位的选择以及手术技术。使用撑开移植物的一些明显优点包括改善鼻内瓣膜功能、可预测性和可靠性。
