Evolution of the butterfly graft technique: 15-year review of 500 cases with expanding indications.

[OBJECTIVES/HYPOTHESIS] To describe the evolution of the butterfly graft technique for the treatment of nasal valve compromise, with specific attention to technical developments allowing for expanded indications. To review the impact on patient-reported outcomes of nasal airway function and nasal aesthetics.

[STUDY DESIGN] Retrospective chart review.

[METHODS] A review of a single surgeon's patients at a private practice and tertiary care center undergoing surgical correction for nasal valve compromise using the butterfly graft technique between July 2002 and April 2017. Data collected included etiology of nasal valve compromise, additional procedures performed, complications, and functional and aesthetic patient-reported outcomes.

[RESULTS] Over the study period, 512 patients underwent surgery to correct nasal valve compromise utilizing the butterfly graft technique. The overall patient-reported relief of nasal obstructive symptoms was complete in 87%, improved but not completely relieved in 10%, and not improved in 4%. No patients reported a worsening in their nasal obstructive symptoms. The overall patient-reported change in nasal appearance was improved 53%, the same 32%, worse in 15%. The patients in the latter half of the study tended to report better aesthetic results.

[CONCLUSIONS] The results of this study suggest that the surgical technique for the butterfly graft evolved over time and allowed for improved aesthetic outcomes, without reduction in the efficacy in correction of nasal valve compromise. The evolution in technique allowed for expansion of the indications for the butterfly graft while maintaining the favorable patient-reported aesthetic and functional results.

[LEVEL OF EVIDENCE] 4 Laryngoscope, 129:S1-S10, 2019.