Middle vault collapse narrows the internal nasal valve and impairs air
flow through the nose. Loss of structural integrity of the upper later
al cartilaginous vault, the cause of the middle vault collapse, is cla
ssically 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 t
he upper lateral splay graft. The splay graft spans the dorsal septum
but is deep to the left and right upper lateral cartilages. The intrin
sic spring in the splay graft elevates each upper lateral cartilage wi
th the septum as Ore fulcrum, thus correcting the middle vault collaps
e and opening the internal valve. The procedure, a physiologic substit
ute for the device ''Breathe Right'' applied externally, has been perf
ormed on nine patients and proved tea be a prodigious functional boon
to all of them. The powerful splay effect, however, can result in exce
ssive widening of the caudal portion of the dorsum with imprudent use
of the technique. Two case reports illustrate thr subjective and objec
tive improvement that was shared in all but one patient. Excess wideni
ng in one patient resulted in a suboptimal aesthetic improvement, alth
ough the functional objectives were met. Identification of suitable pa
tients, preoperative assessment, choice of cartilage donor site, and t
he surgical technique are discussed. Improved internal valve function,
predictability, and reliability are some of the distinct advantages o
f using a splay graft.