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

    • 2017: Repair of Lateral Wall Insufficiency

    • 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

• • 1997: Use of alar batten grafts for correction of nasal valve collapse

  • 2003: Treatment of nasal obstruction from nasal valve collapse with alar batten grafts

  • 2006:Sub-alar batten grafts as treatment for nasal valve incompetence; description of technique and functional evaluation

    • 2014: Alar Batten Grafts - Great article with video

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 

Post-op

High-Yield

Links

• YouTube (2:56): How to insert an Alar Batten Graft | Breathe Right Strip Surgery | Seattle Rhinoplasty