V. RESULTS

With 1-30 months of followup, 170 patients had functional endoscopic sinus surgery (FESS) or FESS/ septoplasty. Specifically, 83 patients underwent FESS, and 87 underwent FESS/septoplasty. Three of these patients, or 1.5%, had alar batten grafts. Ten patients also underwent cosmetic rhinoplasty without batten grafting.

One-hundred-ten patients had septoplasty only for nasal obstruction. Sixty-seven of these patients also had cosmetic rhinoplasty, and 43 underwent septoplasty alone.

Twenty-one patients had septoplasty with place­ment of alar batten grafts, representing 16% of the "septoplasty only" patients. This is a large percentage, but it is notable that 16 of these 21 patients were referred by other otolaryngologists. When these 16 patients are excluded, 3.5% of the "septoplasty only" patients underwent alar batten grafting. This may be more representative of a general otolaryngology practice. Notably, all 21 of these patients noted im­provement in their nasal breathing.

Seven patients underwent ear cartilage harvest with alar batten grafts (Fig. 1). This group is of great interest, because the only intervention for nasal obstruction was placement of batten grafts. All had undergone prior septoplasty and four out of the seven had undergone prior FESS and had per­sistent nasal obstruction. Five noted improvement, one noted partial improvement, and one noted no improvement.

Of the seven patients noted above who underwent alar batten grafting only, five were referred by other otolaryngologists as a result of a suspicion of nasal valve collapse.

FIGURE 2. Precise pocket alar batten graft, surgical technique. (a) The site of the proposed graft may be marked on the skin prior to infiltrative anesthesia. (b) Auricular cartilage is harvested and fashioned into batten grafts. Alar bat-ten grafts are most effective when they extend beyond the pyriform aperture. (c) The grafts are placed through an en­donasal approach via a limited marginal incision. (Photographs reprinted with per-mission from revisionrhinoplasty.com).

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