Upper Lateral Cartilage Fold-in Flap: A Combined Spreader and/or Splay Graft Effect Without Cartilage Grafts

Özmen, Selahattin; Ayhan, Sühan; Fındıkçıoğlu, Kemal; Kandal, Sebahattin; Atabay, Kenan

doi:10.1097/sap.0b013e31816dd359

Cited by 41 publications

(19 citation statements)

References 19 publications

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“…In addition to causing poorer nasal breathing due to collapse of the internal nasal valves, typical adverse sequelae also include development of an inverted V deformity, asymmetries on the lateral nasal walls, and interruption of aesthetic nasal dorsum lines. 11,14 Implantation of spreader grafts has been regarded as the standard method of reconstructing the middle nasal vault since the technique was first described by Sheen. 1 However, the use of spreader grafts involves some potential risks.…”

Section: Discussionmentioning

confidence: 99%

“…Various authors have described the use of spreader flaps as a substitute for traditional spreader grafts in patients with nasal humps during primary rhinoplasty. [7][8][9][10][11][12] However, traditional spreader flap techniques only allow restoration of the natural shape of the middle nasal vault to a limited extent. More important, present spreader flap techniques offer only a limited alteration or adjustment of the width of the middle nasal vault.…”

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confidence: 99%

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A New Classification of Spreader Flap Techniques

Wurm¹,

Kovačević

2013

Facial plast Surg

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Removal of a nasal hump and reduction of the dorsum during rhinoplasty loosens or resects the anatomic connections between the upper lateral cartilages and the septum and bone. The structural arrangement of the middle nasal vault is thus lost. If reconstructive measures are not performed, this often leads to adverse functional and aesthetic sequelae. The lateral walls of the nose and the internal nasal valves may collapse, leading to nasal obstruction. A typical external sign of a collapsed middle nasal vault is the formation of the "inverted V" deformity, with destruction of the natural contours and interruption of the aesthetic lines of the nasal dorsum (►Fig. 1). 1 In patients with a high and narrow nose, a finding of a collapsing lateral nasal wall and collapse of the internal nasal valves is often easily recognizable preoperatively. By contrast, it is more difficult to assess cases in which there are initially no obvious pathological findings in the middle nasal vault but in which there is a high risk of collapse of the internal nasal valves and development of an inverted V deformity. Patients with short nasal bones, thin skin, and weak upper lateral cartilages fall into this category. The aim in these cases is to maintain or restore normal functional and aesthetic anatomy through rhinoplasty.Implantation of spreader grafts is regarded as the standard method for preventing collapse of the internal nasal valves and an inverted V deformity. In functional terms, the grafts move the upper lateral cartilages away from the septum and enlarge the internal nasal valve. In addition, the volume and Keywords ► spreader flaps ► internal nasal valve ► middle vault ► inverted V deformity AbstractThe objective of this study was to introduce various spreader flap technique modifications to adjust the width of the middle nasal vault in patients who underwent rhinoplasties with humpectomy. Decisive modifications of current spreader flap techniques were performed to allow a more natural restoration of the middle nasal vault and the internal nasal valve after humpectomy. Additional steps provide tools to adjust the width and shape of the middle nasal vault according to patients' requirements. The techniques were categorized into "basic spreader flaps," "flaring spreader flaps," "support spreader flaps," and "interrupted spreader flaps." The various spreader flap techniques were used during 576 primary septorhinoplasties in patients with hump noses, hump/crooked noses, or hump/tension noses. The average follow-up was 19 months. Patients who received basic spreader flaps or a flaring spreader flaps tended to show a slightly too wide middle nasal vault, revision surgery was necessary in four of these cases. All other patients showed an appropriate width in the middle nasal vault and an aesthetically pleasing course of the dorsal aesthetic lines. No signs of inverted V deformities or collapse of the internal nasal valve were observed in any of the patients. Patients who had reported impaired nasal breathing preoperatively describe...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A New Classification of Spreader Flap Techniques

Wurm¹,

Kovačević

2013

Facial plast Surg

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“…In reduction rhinoplasties, the internal nasal valve is often affected and narrowed as a result of dorsal hump reduction. A technique recently described by Ozmen et al [2 ] as the upper lateral cartilage fold-in flap eliminates the need for a cartilage graft altogether. In this technique, the upper lateral cartilages are first separated from their junction with the septum.…”

Section: Internal Nasal Valvementioning

confidence: 98%

Trends in functional rhinoplasty 2008

Lee

Constantinides

2009

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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“…In 2008, Ozmen et al 43 reviewed 180 patients after rhinoplasty. They utilized the medial aspect of the ULC cartilage as a turn-in flap to reconstruct the midvault after dorsal reduction.…”

Section: Cartilaginous Dorsum and Ulcmentioning

confidence: 99%