Rhinoplasty - Alar batten graft
Considerations
Indications
Lateral side wall insufficiency (2013: Validation of a grading system for lateral nasal wall insufficiency - Dr. Gabe Tsao)
May address zone 1 and / or zone 2
Nasal valve collapse (2008: The diagnosis and treatment of nasal valve collapse)
Key anatomy and physiology
The nasal valve
Lateral nasal side wall
Graft material, shape, and dimensions
Typically harvested from a portion of septal cartilage or auricular (conchal bowl) cartilage
Rounded shape [think 2-10-20]
1-3 mm in thickness
10-15 mm in width
18-24 mm in length
Dimensions depend on the individual's nasal anatomy
Surgical approach
Both endonasal and external are possible
Variations
Preparation
Procedure
Marginal / rim incision, just long enough to insert the graft, along the lower border of the lateral crura of the lower lateral cartilage
Bluntly dissect the precise pocket with tenotomy scissor, in the marked area, just superficial to the lower lateral cartilage extending on the bony edge of the pyriform aperture superiorly and towards the nostril rim inferiorly
Key: The precise pocket must be placed at the point of maximal collapse
Place the graft perpendicular to the orientation of the lower lateral cartilage extending onto the bone of the pyriform aperture
Many times, this corresponds to the area of the supra-alar crease
Close the incision with 4 0 Vicryl
Usually, no packing is needed