title: [Flaring spreader flaps and upper lateral advancement. Modified techniques in the reconstruction of the internal nasal valve].
abstract: BACKGROUND
  A collapse of the internal nasal valve and the formation of an inverted-V deformity represent common findings following dorsal hump removal in rhinoplasty procedures. Spreader grafts are considered as standard both in the prevention and treatment of such undesirable outcomes. The authors introduce modified surgical concepts using flaring spreader flaps and the upper lateral advancement technique to reconstruct the internal nasal valve.
  
  
  METHODS
  After mobilization of the mucosa and separation of the upper lateral cartilages from the septum also their attachments to the nasal bones are released. The cartilages then are rotated as spreader flaps into the area of the internal nasal valve and can be used as a replacement for conventional spreader grafts. By crucial modifications of commonly applied suture techniques both the contour and airway are improved. The upper lateral advancement technique is used in cases of already present inverted-V deformities. The upper lateral cartilages are mobilized in a similar fashion and serve as attachments to usual spreader grafts.
  
  
  RESULTS
  Flaring spreader flaps have been used in 164 patients undergoing primary rhinoplasty procedures for dorsal hump removals, the treatment of tension noses as well as deviated noses. Postoperatively all cases showed an adequate width of the middle nasal vault and pleasant dorsal aesthetic lines. No signs of an inverted-V deformity or a collapse of the internal nasal valve were present. Nasal breathing was considered significantly improved. The upper lateral advancement technique was applied in 9 patients with a present inverted-V deformity after previous rhinoplasties. During the following revision procedures an adequate reconstruction of the middle nasal vault as well as a subjectively improved airway was achieved in all cases.
  
  
  CONCLUSIONS
  Both flaring spreader flaps and the upper lateral advancement technique represent reliable methods in the reconstruction of the internal nasal valve and treatment of inverted-V deformities. Moreover, flaring spreader flaps can be considered as an appropriate alternative to conventional spreader grafts in patients with only small amounts of cartilage available.
authors.affiliation: Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Universität Erlangen Nürnberg, Waldstrasse 1, Erlangen, Germany. jochen.wurm@uk-erlangen.de
authors.forename: J
authors.initials: J
authors.lastname: Wurm
authors.forename: M
authors.initials: M
authors.lastname: Kovacevic
mesh_terms: D000328:Adult; D002356:Cartilage / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000002:abnormalities* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012225:Rhinoplasty / Q000295:instrumentation* / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult