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A comparative analysis of middle vault reconstruction of the nose by either the sheen or the fulcrum spreader graft in a cadaveric study

Ivo Gwanmesia MD, Rafael Couto MD, Gaby Doumit MD Frank Papay MD
The Cleveland Clinic

Presenter: Ivo Gwanmesia

All the work in this study was carried out by the fellow

Director Name: Dr Frank Papay MD

Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics

INTRODUCTION: Collapse of the internal nasal valve is a common cause of nasal obstruction. Spreader grafts are used to widen the internal nasal valve angle, and by so doing increase the cross sectional area of this part of the nose. Several types of spreader grafts have been described, foremost amongst them are the Sheen and the Fulcrum spreader grafts.
AIMS AND OBJECTIVES: The aim of this cadaveric study was to compare increases in cross sectional area within specific areas in the nose after reconstruction of the middle vault with either the Sheen or the Fulcrum spreader graft using the acoustic rhinometer.
METHOD: 20 fresh cadavers were used for the study. Cross sectional area measurements were taken at 3 points: at the internal nasal valve (CSA 1), at the midpoint of the inferior turbinate (CSA 2), and at the midpoint of the middle turbinate (CSA 3). Middle vault reconstructions were performed by the Sheen or Fulcrum techniques. An acoustic rhinometer provided measurements at the 3 points. Values obtained were analyzed using a paired t-test with significance at p<0.05
RESULTS: Reconstruction of the middle vault with the fulcrum spreader graft provided increases in cross sectional area of 35%, 55%, and 70% at CSA 1, CSA 2 and CSA 3 respectively with p values of 0.029, 0.014 and 0.009 when compared to measurements obtained using the Sheen technique.
CONCLUSION: The results from our study suggest that reconstruction of the middle vault with the Fulcrum spreader graft might be a more effective technique.

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