Technical Modifications of the Butterfly Graft for Black and African American Patients

Introduction: Nasal airway obstruction (NAO) is highly prevalent among patients seen by otolaryngologists and is associated with significant economic burden and reduced quality-of-life. Nasal valve compromise is a primary cause of NAO. There are variations in nasal anatomy by race and ethnicity, so as the racial and ethnic diversity in the U.S. increases, demand for modifications in traditional surgical approaches may increase. Though modifications to the original butterfly graft (BFG) technique have been previously described, we have found that additional modifications make it more functionally successful in Black and African American patients: increasing the tip-to-dorsum projection, intended to remove the counter tension imposed from the skin-soft tissue envelope. The aims of this study were to (1) describe modifications developed to the BFG technique by the senior author for Black and African American patients, and (2) analyze functional outcomes among Black patients before and after the surgical modifications were implemented.

Methods: We compared the senior author’s experience with the BFG on ten Black and African American patients, four prior to this modified technique and six after. Paired t-tests were used to analyze the difference in pre- and post-operative Nasal Obstruction Symptom Evaluation (NOSE) and Rhinosinusitis Disability Index (RSDI) scores. This study was deemed exempt by the IRB.

Results: Among patients who underwent the BFG without the modifications, there was a mean improvement in NOSE scores of 17.5 points (± 2.5) that was not statistically significant (p=0.06). However, among patients who underwent the BFG with the modifications described herein, there was an average improvement in NOSE scores by 61.5 points (± 11, p< 0.001) and RSDI by 18.5 (± 16.9, p=0.04) which were statistically significant.

Conclusions: These data suggest that increasing the tip-to-dorsum projection among Black patients with the BFG in functional rhinoplasty may improve their functional outcomes. We recommend careful preoperative analysis of the tip-to-dorsum projection among Black patients undergoing the BFG.