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

Abstract

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

Utility of endoscopic anatomical optical coherence tomography in functional rhinoplasty

“…This graft is placed over the nasal septum and sutured to the caudal margins of the ULC such that the natural spring of the graft helps both to widen the nasal valve and to reinforce the strength of the ULC. 13 Figure 1 shows the nasal anatomy and gives an overview of the cartilage harvest and graft placements in SG and BFG procedures.…”

Nasal Airflow Changes With Bioabsorbable Implant, Butterfly, and Spreader Grafts

“…The conchal cartilage was then carved as previously described. 15 Next, the graft was placed via an endonasal approach. A limited intercartilaginous incision was then made, and a subnasal SMAS plane was then developed to the level of the rhinion.…”

“…1B). [12][13][14][15] Recently, the use of a less invasive, bioabsorbable nasal implant (BNI) that is designed to reinforce the soft tissues adjacent to the upper and lower lateral cartilages has also been shown effective at improving the sensation of nasal patency, purportedly by stiffening the nasal sidewall (Fig. 1C).…”

External and internal nasal valve. Diagnostic and treatment methods for dysfunction

“…Зона НК считается наиболее узким местом в полости носа и играет при этом важную роль в регуляции потока воздуха . Отсутствие улучшения носового дыхания после хирургического вмешательства на перегородке носа и носовых раковинах у части пациентов служит поводом для критического анализа других причин носовой дисфункции [5][6][7][8] . Проведя обследования 500 пациентов, S .…”

“…Поэтому, с нашей точки зрения, при объективной оценке вентиляционной функции носа методом передней активной риноманометрии особое внимание следует уделять показателям суммарного объемного потока и суммарного сопротивления именно на вдохе . Статический коллапс часто усугубляется динамическим компонентом и наоборот [3][4][5]11] .…”