title: A graded approach to repairing the stenotic nasal vestibule.
abstract: OBJECTIVE
  To describe a graded approach to repairing vestibular stenosis that involves restoring structural support to the ala.
  
  
  METHODS
  Retrospective review of 5 nostrils in 4 patients who presented to the senior author with vestibular stenosis. The cause was burn injury in 3 patients and congenital in 1 patient. The cornerstone is a batten graft to restore strength to the ala. A short-term thermoplastic stent helps the nostril assume its natural shape. When an obstructing cicatrix is present, it is excised in a second stage followed by full-thickness skin grafting. The patients were evaluated up to 16 months postoperatively. Vestibular patency was documented using high-resolution photographs, and medical records were reviewed for complications.
  
  
  RESULTS
  Two patients had their nostrils repaired in a single stage and the others required 2 stages. In all patients, significant improvement in nostril diameter was maintained. The patients were satisfied with the functional and aesthetic results. Stenting averaged 13 days after surgery and was well tolerated. No wound complications occurred.
  
  
  CONCLUSIONS
  In patients with vestibular stenosis, we use a graded approach that addresses the inherent weakness of the nasal ala to achieve long-term vestibular patency. This technique restores form and function to the stenotic vestibule while avoiding long-term stenting.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT 84132, USA. steven.daines@hsc.utah.edu
authors.forename: Steven Marc
authors.initials: SM
authors.lastname: Daines
authors.forename: Grant S
authors.initials: GS
authors.lastname: Hamilton
authors.forename: Steven Ross
authors.initials: SR
authors.lastname: Mobley
mesh_terms: D000402:Airway Obstruction / Q000601:surgery*; D002056:Burns / Q000601:surgery*; D002356:Cartilage / Q000637:transplantation; D004954:Esthetics; D005500:Follow-Up Studies; D006801:Humans; D009666:Nose / Q000002:abnormalities* / Q000293:injuries*; D009667:Nose Deformities, Acquired / Q000601:surgery*; D017060:Patient Satisfaction; D012086:Reoperation; D012225:Rhinoplasty / Q000379:methods*; D015607:Stents