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Surgical Pearls |

Alar Batten Grafts

Dennis Y. Chua, MBBS1; Stephen S. Park, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, University of Virginia, Charlottesville
JAMA Facial Plast Surg. 2014;16(5):377-378. doi:10.1001/jamafacial.2014.490.
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The alar batten graft is the workhorse for functional rhinoplasty and used when there is collapse at the sidewall.1 This graft is used to support the lateral nasal wall and/or lower lateral cartilage and prevent collapse during inspiration. It is not intended to create a major change in resting anatomy, nor does it address middle vault narrowing. The anatomic epicenter of collapse varies but is most often at the intervalve area—the space between the internal and external valves, underlying the supra-alar crease. Recurvature of the lateral crura frequently coexists and can be corrected this way. Occasionally, the graft needs to be placed more caudally, within the alar lobule itself, to lend some support to the external valve. Thus, the preoperative assessment is critical for determining the exact location of dynamic collapse. Both endonasal and external approaches are possible, although the latter is used more frequently because of multiple grafts and sutures.

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Figure 1.
Conchal Bowl Cartilage

Two alar batten grafts can usually be fashioned from 1 conchal bowl cartilage.

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Figure 2.
Placement of Alar Batten Graft at the Site of Maximal Nasal Collapse

The graft is typically angled slightly caudally with the lateral aspect resting on the bony pyriform aperture to ensure that it does not collapse medially.

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