Revisiting the upper lateral splay graft: A modified technique for improving internal nasal valve obstruction.

In this paper we present our findings and specific modifications that make the splay graft a more useful adjunct to the armamentarium of upper vault augmentation techniques. On retrospective review of our cases we identified seven patients that required a modified splay graft over a 15 year period. A paper chart and electronic image review was conducted. The surgical technique is described with accompanying diagrams and clinical images to further illustrate the technique. Despite the many techniques reported in the literature diagnosis and management of the dysfunctional internal nasal valve is still somewhat ambiguous however, all methods described work by two main principles: strengthening the flaccid upper lateral cartilages (ULC) or nasal sidewall preventing collapse, or widening the angle and surface area of the internal nasal valve. The proposed modified splay graft has proved a useful technique in our experience of upper vault augmentation in cases of nasal obstruction secondary to internal nasal valve dysfunction. By improving both aspects, increasing the INV angle and strengthening the nasal side wall we produce a greater impact on the internal nasal valve area and reduce the risk of obstruction at this point.