Figure 6: Various methods of middle vault reconstruction.
a) The upper lateral cartilages display a natural curvature at their transition to the septum. b) Separation of the upper lateral cartilage from the septum. c) Suture-fixation of a standard spreader grafts increases the nasal valve area, but reduces the nasal valve angle by rotating the upper lateral cartilages slightly inward. d) Spreader grafts with a trapezoid shape are better suited to reconstruct the nasal valve angle. e) Onlay spreader graft is suitable to correct nasal valve pathology and dorsal deficiencies at the same time. f) Modified dorsal onlay graft rotates upper lateral cartilages more markedly outward, but requires sufficient height of upper lateral cartilages for suture to the graft. g) Endonasal, submucosal placement of spreader grafts allows for correction of the middle third of the nose without separation of the upper lateral cartilage form the septum. h) Turn-in spreader graft utilizes medial most aspects of the upper lateral cartilage to fold on itself and act as spreader graft.