UPPER LATERAL SPLAY GRAFT

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.