Spreader Flap Research Articles

Comparison of Functional and Cosmetic Outcomes Between Dorsal Preservation and Spreader Flap Rhinoplasty: A Randomized Trial.

Preservation rhinoplasty is a novel and increasingly utilized method in nasal plastic surgery. The study aimed to compare the functional and aesthetic outcomes of dorsal preservation rhinoplasty, a new and interesting method, with conventional hump resection. A total of 84 rhinoplasty applicants were randomly assigned to 2 groups. The first group underwent convention dorsal hump resection with spreader flap midvault reconstruction and the second group underwent dorsal preservation rhinoplasty with the modified subdorsal strip method. Aesthetic and functional outcomes, including residual hump, nasal width, projection, and rotation, were evaluated after 1 year with the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS), visual analog scale (VAS), and image analysis. Eighty-four patients with a mean age of 30.96 ± 6.75 years were recruited, of whom 15 (17.6%) were male. There were no significant differences in confounding variables between the 2 groups. There were no significant differences in residual hump (P = .11), nasal width (P = .37), projection (P = .70), rotation (P = .79), VAS (P = .81), or SCHNOS (P = .90) between the 2 groups. Dorsal preservation rhinoplasty with the modified subdorsal strip method may have comparable aesthetic and functional outcomes to spreader flaps midvault reconstruction.

Comparison of the Effects of Spreader Graft Versus Spreader Flap on Nasal Valve Angle in Open Approach Rhinoplasty.

This study aimed to compare the spreader graft and flap techniques, which are used in nasal valve surgery, based on measurements of nasal valve angles using computed tomography. In this retrospective study, all patients' right and left internal nasal valve angles were measured from coronal computed tomography images taken preoperatively and in the third postoperative month. A paired t-test and independent t-test were used to compare continuous numerical variables. There were 52 patients with 104 valves in the spreader flap group and 54 patients with 108 valves in the spreader graft group, with a mean age of 27.76 ± 8.16 years. The angles were found to be statistically significantly higher in the postoperative period (p<0.001) in all patients. While the angles did not differ significantly between the flap and graft groups in the preoperative period, they were significantly higher in the flap group in the postoperative period (p<0.001). It is essential to preserve nasal valve function in rhinoplasty. The findings show that a spreader flap is superior to a spreader graft, although both techniques increase internal nasal valve function. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Computational Analyses of Physiologic Effects After Midvault Repair Techniques in Rhinoplasty

Background: Midvault reconstruction is an essential element of functional rhinoplasty. An improved understanding of airflow patterns after spreader graft (SG) or spreader flap (SF) techniques can inform surgical techniques based on individual anatomy. Objectives: The objective of this study was to compare the physiologic changes related to nasal function after midvault reconstruction with SF and SG. Methods: Soft tissue elevation (STE), SG, and SF were performed in sequence on 5 cadaveric specimens. Computational modeling was used to simulate airflow, heat transfer, and humidity in three-dimensional nasal airway reconstructions of each specimen. Results: Median bilateral airflow-rates (L/min) were similar for STE (29.4), SF (27.6), and SG (28.9), and were not statistically significant (STE vs SF: P = 1.0, power = 5%; STE vs SG: P = .31, power = 16%; SF vs SG: P = .42, power = 14%). Both SF and SG had increased unilateral airflow volume (L/min) through the more obstructed nasal passage (median: STE 10.3, SF 12.2, SG 12.7), but these differences were not significant (STE vs SF: P = .19, power = 24%; STE vs SG P = .19, power = 30%). Furthermore, SF and SG had decreased unilateral nasal resistance (Pa s/mL) on the more obstructed side (median: STE 0.085, SF 0.072, SG 0.062) (STE vs SF: P = .13, power = 23%; STE vs SG P = .13, power = 24%). For all 3 models, heat flux distribution was greater in the anterior portion of the nasal passage than the posterior portions. Conclusions: Differences in nasal airflow and resistance after SF and SG were not statistically significant, but both procedures resulted in higher airflow rates and decreased nasal resistance through the more obstructed nasal passage.

A Novel Technique for Spreader Flap by Folding the Dorsal Hump in Patients Undergoing Primary Rhinoplasty

We describe our novel modified spreader flap, which involves keeping the large cartilaginous septal T hump attached to the upper lateral cartilages to increase the thickness and length of the flap. Our objectives were to assess hump reduction and recurrence, nasal axis deviation, dorsal width, internal nasal valve grade, and Rhinoplasty Outcome Evaluation (ROE) score preoperatively and one year postoperatively. In a prospective study that included 21 patients who met the criteria, patients were followed up for 1 year after surgery, with an assessment of the dorsal projection, tip projection, axis deviation, dorsal width, and internal nasal valve grade. In addition, the modified Cottle maneuver and Rhinoplasty Outcome Evaluation score were also performed and obtained, respectively. Our novel technique was performed in 20 patients (95.2%). In 1 additional patient, we added a regular auto-spreader flap on the contralateral side. One year postoperatively, the axis was found in the midline in all patients (100%). Assessment of internal valve collapse showed that collapse was reduced to grade 0 in 13 patients (61.9%) and grade 1 in 8 patients (38.1%). There were no hump recurrences or visible irregularities. The results showed a statistically significant difference between the pre- and postoperative values in dorsal projection, dorsal width, and rhinoplasty outcome evaluation score. This novel technique shows promising statistically significant results in reducing dorsal hump projection and width, correcting axis deviation, and improving internal nasal valve and rhinoplasty outcome evaluation score, while being less cartilage and time-consuming.

Complications Associated with Spreader Grafts and Spreader Flaps: A Systematic Review.

Spreader grafts and spreader flaps are one of the most common techniques utilized in rhinoplasty surgeries. The aim of this study was to determine the complications, satisfaction, and revision rates associated with spreader grafts and spreader flaps and to compare these two modalities. PRISMA guidelines were followed for conducting this systematic review. The authors searched the literature systematically for pertinent materials in PubMed/Medline and Google Scholar. Inclusion criteria of this search included: randomized and non-randomized clinical trials, cohorts, and case series with more than 5 participants on rhinoplasty using spreader grafts or spreader flaps with detailed report either on complications, revision, and satisfaction rates. Furthermore, exclusion criteria included: any cadaveric or non-human study, case reports, technical notes, and review articles. The initial literature search yielded a total of 193 studies. Following screening each paper and implementing the inclusion and exclusion criteria, 40 articles were chosen. In the spreader graft group, from 21 studies reporting complications, 6 of them reported no complication. The most common complications were nasal obstruction, inverted V deformity and open roof deformity, deviation, and infection. In the spreader flap group, from 6 studies reporting any existing complications, 1 reported no complications. Five other studies reported some degree of complications. In terms of revision rate, 10 patients (0.62%) underwent revision surgery after spreader graft placement, while only 2 patients (0.35%) revised surgically in the spreader flap group. These two methods seem to have no significant difference in terms of complication rates, and both are recommended as a choice in middle vault reconstruction when each of their clinical use is indicated. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Spreader Graft vs Spreader Flap in Rhinoplasty: A Systematic Review and Meta-Analysis of Aesthetic and Functional Outcomes.

Insufficient support of the nasal mid-vault during rhinoplasty can cause significant complications. Accordingly, surgeons have recently paid much more attention to the preservation of nasal patency. The spreader graft is the gold standard technique for the reconstruction of nasal mid-vault. The objective of this study was to compare the spreader graft and spreader flap in terms of aesthetic and functional outcomes. An inclusive search was performed with PubMed/Medline, Google Scholar, and Cochrane Library databases up to April 2021. Multiple aesthetic and functional factors, including dorsal aesthetic lines restoration, satisfaction rate, internal nasal valve angle improvement, nasal obstruction symptom evaluation scale, and active anterior rhinomanometry were evaluated. Also, a meta-analysis was performed on the included articles that provided adequate data for mentioned factors. After excluding papers that did not conform with the selection criteria, 10 articles with a total sample size of 567 cases with a mean age of 27.7 years (range, 18-65 years) were finally included. Analysis of the data revealed no statistically significant difference between the spreader graft and spreader flap techniques in terms of dorsal aesthetic lines restoration, internal nasal valve angle improvement, nasal obstruction symptom evaluation scale, and anterior rhinomanometry. However, in terms of satisfaction rate, the analyzes indicated that spreader graft has significantly superior aesthetic outcomes. Generally, in case of appropriately selected patients, there is no statistically significant difference between spreader graft and spreader flap techniques in terms of aesthetic and functional outcomes.

Evaluation of functional outcomes of spreader graft and spreader flap used in rinoplasty

Evaluation of functional outcomes of spreader graft and spreader flap used in rinoplasty

Four-Step Spreader Flap: The Pull-Twist-Turn Technique.

The spreader (or autospreader) flap offers an alternative to the traditional spreader graft in reconstructing the dorsal midvault and preserving internal valve function. This is of particular importance after an aggressive dorsal hump reduction, which has the potential to result in an inverted-V deformity, dorsal narrowing, or saddle-nose deformity. In this article, the authors describe a four-step spreader flap technique that offers a simple, reproducible method of shaping the dorsal midvault while preserving internal valve function.

Optimal harvest and efficient use of septal cartilage in rhinoplasty.

BackgroundNasal septal cartilage is used to obtain favorable aesthetic and functional outcomes in rhinoplasty, but is often difficult to harvest or the harvested amount is insufficient. Therefore, the objective of this study is to introduce how to harvest septal cartilage optimally without losing and use harvested cartilage efficiently.MethodsFrom March 2015 to January 2020, we tried to harvest as much septal cartilage as possible while maintaining the L-strut in 30 patients. A spreader flap and septal rotation suture were used instead of a spreader graft. Also in patients who needed a spreader graft and septal extension graft, a spreader graft was used on one side and a one-piece spreader graft combined with a septal extension graft was performed on the other side. For tip plasty, a columella septal suture was performed first. Postoperative patient satisfaction was assessed using the Rhinoplasty Outcome Examination questionnaire.ResultsNo serious complications were observed. The patient satisfaction score was 50% or above in 27 patients (90%) and less than 50% in only three patients (10%). The average score was 81.5 points.ConclusionFor septal cartilage deficiency, a spreader flap, the septal rotation suture, or one-piece spreader graft combined with a septal extension graft was used. The nasal tip was sufficiently rotated using the columellar septal suture technique first. These techniques made it possible to obtain good aesthetic outcomes using only septal cartilage, without harvesting other cartilage.

Evaluation of the use of Different Spreader Techniques in Primary Open Septorinoplasty in Terms of Nasal and Olfactory Functions.

In this study, the authors aimed to investigate the use of spreader and determine the efficacy and superiority of different spreader techniques in septorhinoplasty in terms of nasal and olfactory functions. A total of 60 patients who had undergone septorhinoplasty with the open technique were included in the study. In addition to open septorhinoplasty, 20 patients also underwent bilateral spreader graft placement and 20 bilateral spreader flap placement. For the remaining 20 patients, open septorhinoplasty was performed without spreader grafts or flaps. The patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale consisting of five questions, and the Brief Smell Identification Test was used to detect olfactory dysfunction. The preoperative mean NOSE score of all patients was 10.87 (1-18), while the postoperative mean value was 1.83 (0-10). The preoperative mean olfactory score was 6.23 ± 2.20 in all patients while it was 7.33 ± 1.75 postoperatively. There was a statistically significant difference between the preoperative and postoperative NOSE and olfactory scores in all patients, but no statistically significant difference was observed between the three groups. Spreader graft or flap techniques used in septorhinoplasty are safe in terms of nasal obstruction and olfactory function, and there is no statistically significant difference between them.

Mucoperichondrial Spreader Flap Application for Middle Vault Reconstruction in Rhinoplasty: A Review of 857 Cases.

Mucoperichondrial Spreader Flap Application for Middle Vault Reconstruction in Rhinoplasty: A Review of 857 Cases.

The Combined Use of Spreader Flap and Asymmetric Spreader Graft in Crooked Nose.

The crooked nose is still a challenging deformity for rhinoplasty surgeons although a significant number of correction methods have previously been described. The aim of this study is to present a new technique that the authors have used to correct the crooked nose in selected patients. This retrospective study was carried out on 53 patients who underwent open technique rhinoplasty due to crooked nose. Pictures were taken from five different angles using digital cameras and recorded pre- and postoperatively. Patients who have a minimum follow-up period of 12 months are included in the study. Fifty-three patients who have I-shaped and C-shaped crooked nose were enrolled in this study. The mean ages were 27.4 years. The mean follow-up period of the patients was 19.1 months. Patients who have I-shaped and C-shaped crooked nose deviation angle values were calculated preoperatively as 7.1 ± 2.1 and 163.4 ± 3.6, respectively. Postoperatively, deviation angle values were 0.75 ± 0.83 and 177.9 ± 3.1. Postoperative deviation angles were significantly lower than preoperative angles on patients who have I-shaped crooked noses (p &lt; 0.001). On patients who have C-shaped crooked nose, postoperative deviation angles were significantly higher than preoperative angles (p &lt; 0.001). This unique study shows that the combined use of one-sided spreader flap and asymmetric spreader grafts is a very good choice for satisfactory long-term outcome and durable correction of crooked nose deformity. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Spreader Flap versus Spreader Graft in Dorsal Reconstruction following Hump Resection in Primary Closed Rhinoplasty

Objectives: To evaluate outcome of spreader flaps versus the spreader grafts in reconstruction of the nasal dorsum after large hump resection. This includes both functional and aesthetic aspects.Patients and Methods: Thirty patients seeking rhinoplasty for dorsal nasal hump. All surgeries were done through the closed approach. Patients were randomly divided into two groups and accordingly to the modality of nasal dorsal reconstruction after hump resection. Group (A) patients were scheduled for reconstruction using spreader grafts while in Group (B) spreader flaps were used. Evaluation included functional and aesthetic considerations. Functional subjective evaluation was done by Nasal Obstruction Symptom Evaluation (NOSE) score and objective assessment by active anterior rhinomanometry (AAR). Aesthetic evaluation included patients’ assessment of their problem according to Visual Analogue scale (VAS) while objective evaluation was done based on a suggested scoring system designed by the authors using pre and post-operative photography. The evaluating surgeons were blinded regarding the vault reconstructive modality.Results: In both groups significant improvement in both functional and aesthetic outcome - after a minimum of three months follow up- when comparing the pre and postoperative data that was obtained. There was no statistically significant difference in outcome between both groups.Conclusion: The spreader flap is a good alternative to the spreader graft in nasal dorsal reconstruction after large hump resection giving similar positive results both functionally and aesthetically however, the authors find the autospreader flap more superior to spreader graft technique as it does not require cartilage harvest.

A Novel Hump Reinsertion Technique to Reconstruct the Nasal Dorsum.

Nasal hump removal and modification is a commonly performed procedure in rhinoplasty. The spreader flap is most commonly used in the reconstruction technique and involves suturing the medial end of the upper lateral cartilage (ULC) onto the septum. In this study, author presents a new hump removal technique that includes a novel procedure for hump reinsertion and suturing that is easy and comfortable to apply in hump removal operations. The records of the patients were assessed retrospectively from private practice. Patients who had undergone hump removal operations using a hump reinsertion graft were included. In total, 54 patients met the inclusion and exclusion criteria, and their records were assessed. The hump was divided into 3 parts longitudinally. The septum, which is a part of the nasal hump, was prepared as a strut graft, and the ULCs were prepared as spreader grafts. A novel suturing technique was used while the spreader grafts were fixed. This technique was used if the ULC was larger than 3 mm. The patients were evaluated using the "Rhinoplasty Outcome Evaluation" (ROE) 12 months after surgery. The initial median ROE score was 40.5; after surgery, it increased to 88.5. The ROE score changed significantly (P < .001). The postoperative results were satisfactory. After assessments, no asymmetry or functional problems were found in all participants. This technique allows for closed rhinoplasty without the need for an additional graft from the septum, enhancing the prevention of displacement and improving functionality.

True and Average Internal Nasal Valve Area in Septorhinoplasty: Radiological and Clinical Outcomes.

The internal nasal valve provides most of the upper airway resistance; therefore, many surgical techniques have been developed to reconstruct and widen this sensitive area of the nasal airway. Twenty patients participated in this study to compare the effects of 2 techniques (spreader grafts and modified spreader flap) on the true valve area and the average valve area after rhinoplasty according to standard axial computed tomography on admission and 6 months following the surgery. The mean follow-up time was 10.2 months. After rhinoplasty, the average valve area increased in all patients who underwent the spreader graft or modified spreader flap techniques. The preoperative average valve areas for patients undergoing the spreader graft and spreader flap techniques were (37.10 ± 16.45 mm) and (36.86 ± 10.56 mm), respectively, whereas the postoperative results were (48.58 ± 12.85 mm) for those who underwent the spreader graft technique and (56.22 ± 19.06 mm) for those who underwent the modified spreader flap technique. Both techniques resulted in significant radiological and clinical improvement with a good correlation between the subjective and objective tests. LEVEL OF EVIDENCE: IV.

The Aesthetic and Functional Roles of Spreader Flap in Primary Rhinoplasty

Dorsal hump resection was considered as the most ordinary part of rhinoplasty. It is obviously noticed that when a humpectomy is performed in a primary rhinoplasty, some surgeons underestimate the middle third (internal valve) reconstruction resulting in an inverted-V deformity. Although spreader graft is the gold standard for middle vault reconstruction, attention is turned to returning a portion of the hump following dorsal reduction in an attempt to reconstruct the middle vault. The aim of this study is to evaluate the use of spreader flap in primary rhinoplasties. This study included 40 patients classified into 3 groups as follows: (1) type I—mild cartilaginous hump, (2) type II—moderate cartilaginous hump, and (3) type III—huge cartilaginous hump. The results are satisfactory in most cases regarding the aesthetic and functional outcomes. Using auto-spreader flaps is shown to be simple, reproducible, and effective in shaping the midvault while keeping the internal valve intact.

Objective Comparison Between Spreader Grafts and Flaps for Mid-Nasal Vault Reconstruction: A Randomized Controlled Trial.

The goal of rhinoplasty is not exclusively aesthetic and the nasal function should always be considered. Several rhinoplasty techniques can participate in nasal valve dysfunction (eg, dorsal hump reductions). Therefore, mid-nasal vault reconstruction by spreader grafts or flaps is mandatory in these cases. To date, there is a literature gap in comparing both techniques objectively. This study shows an objective comparison between spreader grafts and flaps for mid-nasal vault reconstruction. This study was a double-blind randomized controlled trial including 40 patients who were randomly divided into 2 groups. Group 1 (20 patients) underwent spreader grafts insertion, whereas group 2 (20 patients) underwent spreader flap placement technique. Pre-operative active anterior rhinomanometry measurements were compared to 6-month post-operative measurements. Data were summarized as mean (standard deviation) for the quantitative variables. Comparisons between the 2 groups were done using unpaired t test. In both groups, a significant decrease in nasal resistance was noted in both the right and left sides 6 months post-operatively (P < .001). However, the comparison between the 2 both groups showed no statistical significance. Both spreader grafts and flaps, which are used for the mid-nasal vault reconstruction, have comparable and effective results in reducing the nasal resistance as evidenced by active anterior rhinomanometry measurements.

The Use of Spreader Grafts or Spreader Flaps—or Not—in Hump Reduction Rhinoplasty

Hump reduction is one of the most common reasons patients seek cosmetic rhinoplasty. Spreader grafts or spreader flaps have become a key maneuver in supporting and reconstructing the nasal midvault after reductive profileplasty to prevent long-term functional and cosmetic sequelae. This article reviews the pertinent anatomy, describes indications for spreader graft or spreader flap placement, discusses surgical techniques and approaches for spreader graft placement, and describes complications of spreader graft use after hump reduction.

Assessment of Vertical Triangular Spreader Graft Technique for Reconstruction of Middle Vault and Internal Nasal Valve Angle.

Rhinoplasty is a surgical procedure to smooth out the nasal deformities and to fix nasal breathing problems. Spreader grafts and flaps are used to prevent some complications such as middle vault collapse, narrowing the internal nasal valve and inverted V deformity. To obtain more stable middle vault, spreader grafts and flaps could be used together. Many researchers have tried different graft and flap techniques to reach more successful aesthetic and functional results. In this research, we investigated effects of triangular graft on the internal nasal valve angle, nasal breathing, and aesthetic outcomes when it used together with sprader flap. In this prospective study, 3 different groups were formed as: the spreader flap group (group 1); the spreader flap with the rectangular spreader graft group (group 2); and the spreader flap with the triangular spreader graft group (group 3). Preoperative nasal obstruction symptom evaluation (NOSE) scale was used to evaluate nasal breathing and visual analog scale (VAS) was used to evaluate aesthetic appearance. And also, measurement of the internal nasal valve angle was performed for each patients. These evaluations were repeated at postoperative 3rd month. Preoperative and postoperative comparisons between study groups were performed. There were 12 patients in group 1, 14 patients in group 2, and 10 patients in group 3. In each group, statistically significant decrease in NOSE scores (P < 0.05) and statistical significant increase in VAS scores (P < 0.05) were observed. And also, increased internal nasal valve angle after surgery was detected in all groups (P < 0.05). Postoperative NOSE and VAS scores were found similar in 3 different groups (P > 0.05). On the contrary, the internal nasal valve angles were found statistically significant increased in group 3 according to other groups (P < 0.05). The results of this prospective study presented that the use of triangular spreader graft with spreader flap was an appropriate technique to obtain successful aesthetic and functional outcomes with widening the internal nasal valve angle.

The Composite Spreader Flap.

The effect of a spreader flap on the keystone area and the upper bony vault depends on the structural strength and cephalic extent of upper lateral cartilages, both of which can be significantly variable among individuals. The authors present a novel cephalically extended osseocartilaginous composite spreader flap technique that was designed to overcome the limitations of a conventional spreader flap on the keystone area upper bony vault, in patients with cephalically short and structurally weak upper lateral cartilages and thin nasal bones. This study was a retrospective review of the recorded perioperative information to investigate the frequency of the use of the composite spreader flap technique and perioperative parameters that relate to postoperative dorsal deformities. One-hundred-seventy-six consecutive primary open approach rhinoplasty cases performed by the first author (O.B.) between November 2015 and February 2017 were included in the study. Patient data were obtained from rhinoplasty data sheets, standardized photographs, and postoperative physical examinations. Of the 176 cases who underwent primary open approach rhinoplasty whose data were reviewed for the purpose of this study, 38 (32 females, 6 males) had dorsal reconstruction with the use of a composite spreader flap. Seventeen patients had a deviated nose with an asymmetric bony pyramid. In 8 patients, the composite spreader flap was used unilaterally. No patients in the composite spreader flap group had a postoperative dorsal deformity or required surgical revision. Composite flap preparation extends the reliability and the reach of the spreader flap technique beyond its previous borders.