Cadaveric Assessment of the Butterfly Graft in Rhinoplasty.

[INTRODUCTION] The rhinoplasty butterfly graft is used to improve the internal nasal valve (INV), but post-operative visibility remains a concern. Intraoperative techniques have developed to thin the graft with unknown effect on functionality.

[OBJECTIVES] Improve understanding of how to modify the aesthetics of the butterfly graft without impacting patient outcomes. Determine how graft contouring affects its biomechanical properties.

[METHODS] Cadaveric cartilage grafts were used to examine the biomechanics in its native state and with progressive thinning. The force needed to stabilize the INV in an unaltered state and the resistance force provided by native (original), partially thinned, and fully thinned cartilage grafts were recorded.

[RESULTS] The mean thickness of grafts in their natural state was 1.64 mm, median 1.50 mm (SD 0.64 mm). The fully-thinned mean was 0.84 mm, median 0.8 mm (SD 0.18 mm). The mean force (N) of the native graft was 0.74 N and 0.60 N for fully thin (p = 0.016, 95%). The mean force (N) needed to stabilize the INV was 0.15 N (right) and 0.19 N (left).

[CONCLUSION] Butterfly grafts can be thinned by approximately 50% of their original thickness and retain the strength to stabilize the INV.

[LEVEL OF EVIDENCE] NA Laryngoscope, 134:1638-1641, 2024.