Spreader Grafts Research Articles

Proximal Intact Spreader Graft in Let-Down Dorsal Preservation Rhinoplasty.

Grafts and flaps play significant roles in rhinoplasty procedures, while spreader grafts are commonly used. Spreader grafts are placed into submucosal pockets between the upper lateral cartilage and nasal septum. Occurrence of deviation can be seen on nondeviated noses after let-down or push-down methods are performed as the part of the upper septum that has been let-down may cause pressure on the lower septum and that results in deviation. In the present study, the author aimed to demonstrate the benefits of using a proximal intact spreader graft to support the nondeviated nasal septum or to correct the deviated septum in patients undergoing dorsal preservation rhinoplasty. In deviated noses, the upper septum is brought down to the opposite side of the deviation, and a proximal intact spreader graft is placed between the upper and lower septum to correct the deviation and make the dorsum nondeviated. This technique is suitable for patients with a slight to moderately deviated caudal part of the septum. It is unsuitable for patients with severe, cross, or S-shaped deviation. This technique aims to preserve the condition of the nondeviated nose and convert it into a nondeviated state in the let-down technique. The combination of proximal intact spreader graft and dorsal preservation rhinoplasty techniques effectively addresses dorsal hump and dorsal deviation deformities, enhances upper lateral cartilage concavity, prevents W-ASA segment collapse, and both prevents and improves internal nasal valve collapse. The data of patients who underwent dorsal hump reduction with the let-down technique were screened. According to inclusion and exclusion criteria, 95 patients were included in the study (68 females and 27 males). The ROE score before the operation was 51.5. After 12 months, it was found to be 91.5 points, and the change in the ROE median score was significant (P < 0.001). This new proximal intact spreader graft method presents a suitable approach for surgeons to prevent any let-down-induced deviation problems that may occur after the procedure and to correct the present deviation. It will also lead to better cosmetic and functional outcomes for patients who have hump deformity.

Vertical Sectioning of the Cartilaginous Vault for Rhinoplasty: Technique and Assessment.

To describe and assess the vertical sectioning technique for mid vault dissection in patients undergoing primary and secondary rhinoplasty. A retrospective review of 208 patients undergoing primary or revision rhinoplasty utilizing the vertical sectioning technique. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to patients pre- and post-operatively. A detailed description of the technique is presented. Mean follow up was 8.59 ± 7.30 months. Spreader grafts were used in 185 patients (89%), upper lateral cartilage autospreader flaps were utilized in 16 patients (7.7%), and both spreader grafts and autospreader flaps were used in 7 patients (3.4%). Ten primary rhinoplasty patients (4.8%) and 3 revision rhinoplasty patients (4.5%) complained of functional nasal obstruction post-operatively. At time of last follow-up, there was a significant improvement in mean NOSE scores for patients receiving spreader grafts (71.2 ± 21.4-21.5 ± 2.8, P < .001), autospreader flaps (69.2 ± 25.9-17.2 ± 21.5, P < .001), and both (57.9 ± 35.0-26.1 ± 20.2, P = .03). The vertical sectioning technique respects the anatomic, functional, and esthetic relationship of the middle vault, while maximizing cartilage preservation.

Comparative Study between A unilateral and Bilateral Spreader Grafts with Collumellar Strut to Overcome C-shaped Crooked Nose

Comparative Study between A unilateral and Bilateral Spreader Grafts with Collumellar Strut to Overcome C-shaped Crooked Nose

Improving the Supraalar Groove Aesthetic Subunit and Lateral Crura Convex-Concave Deformity.

Lateral crura surface problems are one of the most difficult challenges in nose tip surgery. Closed Preservation Rhinoplasty (CPR) is a revolutionary concept keeping nose tip flexibility and elasticity. Solving lateral crura surface problems and keeping tip flexibility the surgeon will accomplish a sharper supraalar groove transition between the dorsum and the tip. The convex-concave lateral crura deformity (CCLCD) or S shape lateral crura is one of the biggest constraints to accomplish a beautiful tip and dorsum-tip transition (DTT). This deformity is the reason of commonly said parenthesis deformity of cephalic malposition. This LLC convexityconcavity shape creates a C shape shadow. This DTT is one of the key areas to accomplish natural results and it depends on different nose structures, not just the lower lateral cartilages (LLC). A total 560 rhinoplasty cases were studied retrospectively between September and December 2023. Three hundred and twenty patients had at least 1 year of follow-up. Patients had follow-up at 2 weeks, 1 month, 3 months, 6 months and 1 year after surgery. No secondary rhinoplasty was included. Just 2 secondary septoplasty cases were included without any nose skin undermining in the previous surgery. Surgical details were documented, including the 6 fundamental steps of this technique (1) mucosal lower lateral incision, (2) dorsum subperichondral dissection and vertical scroll release, (3) lateral crura tail caudal release, lateral crura steal and slide under flap lateralization, (4) upper laterals caudal resection, (5) vertical scroll reconstruction, and (6) turning point extension graft. Three hundred and twenty patients had at least 1 year of follow-up. 516 underwent a closed approach and 47 patients an open approach. All patients had subperichondral dissection of the hump envelope. All patients who underwent a closed approach had a low strip let down dorsal preservation technique. All patients who underwent an open approach had structural technique with spreader flaps or grafts at the keystone area. All the patients underwent their osteotomies with a piezoelectric device. Twenty-three revision surgeries were necessary. CPR taught us how important ligament and soft tissue preservation are. It taught the less damage you do to the nose soft tissues and scaffold the less support you need on it. Surgeons have been over grafting the lateral crura to solve postoperative problems mainly due to dissection problems and lack of lateral crura support. This paper shows how to solve lateral crura surface problems keeping the tip flexible and elastic creating also a nice and natural supraalar groove transition by applying 6 surgical manoeuvres.

Open-Roof Deformity: How to Avoid, How to Cure?

Objectives: Of all the face surgeries, rhinoplasty is known to be the most difficult. The aim of this paper is to review open-roof deformity. Methods: PubMed, EBSCO, UpToDate, Proquest Central at Kırıkkale University, and Google and Google Scholar were used in the literature review. The search was performed with the keywords "open roof deformity," "rhinoplasty," "fillers" between 2024 and 1980. Results: Rhinoplasty is a surgery that requires a combination of art and science, unlike other procedures that may have challenging anatomic access, requiring an excessive amount of physical strength, or a long operating period that causes surgeon fatigue. It is common for people undergoing primary rhinoplasty to have their hump removed, which can lead to open-roof deformity. Lateral osteotomies and the use of grafts are crucial in the prevention of open-roof abnormalities. It is common practice to perform lateral osteotomies to seal this space. However, lateral osteotomy becomes tricky when the patient's bony vault is small. Another well-known option is to shape and replace the hump or to use a spreader graft, flap, sliced cartilage, or some combination of these. HA filler can also be administered to achieve the same effect as a spreader graft. Along the length of the dorsum on both sides, HA is injected retrogradely. Conclusion: If there are dorsal irregularities after surgery or if there is a need to fix the look of nasal bridge, this therapy can help.

Septal Extension Spreader Graft Combined With Warped Alar Batten Graft for Improvement of Nasal Tip and Alar Asymmetry in Adult Cleft Lip Nasal Deformity.

This paper presents the findings of an observational study involving 38 patients to evaluate the application of a surgical technique utilizing an autologous costal cartilage scaffold for correcting nasal tip and alar asymmetry in unilateral cleft lip-nasal deformity. Nasal septum extension spreader grafts (SEG) and warped alar batten grafts, both made from autologous costal cartilage, were utilized in open rhinoplasty procedures. The warped alar batten graft was fixed to the caudal end of the SEG, with the lower lateral cartilage on the cleft side suspended to the free part of the newly created warped alar batten graft to lift the collapsed nasal alar further. Measurements of nasal tip height, nostril height, and the intersection angle of the nasal sill and alar (α) were taken before and after surgery, comparing the ratios between the normal and cleft sides. Patients were followed up for 2.5 to 5.5 years, with all cases showing successful healing and no complications. Postoperative improvements in nasal tip and nostril asymmetries were significant, with statistically significant changes observed in nasal tip height, nostril height, and the intersection angle of nasal sill and alar (α) ( P <0.05). The combined use of SEG and warped alar batten graft, both crafted from autologous costal cartilage, effectively corrected nasal tip and alar asymmetry in adult cleft lip nasal deformity cases.

Incisor Show Based Selection of Tip Augmentation Rhinoplasty Technique.

Our recent studies show that the majority of patients seeking rhinoplasty have inadequate incisor show. Furthermore, that some rhinoplasty maneuvers, such as a columella strut can alter the lip position and consequently the incisor show. We report the senior author's algorithm for tip augmentation technique based on our prior studies and 44 years of rhinoplasty keen observations. The five most common scenarios are described. When there is a short columella with inadequate incisor show, bilateral extended spreader grafts and columella strut with a tapered posterior portion are recommended, serving as a reliable midline septal extension graft supporting the medial crura in a more anterior position with sutures and a positive effect on incisor show. When there is optimal lip/incisor relationship, a columella strut with a tapered posterior end fixed to the septum, with or without extended spreader grafts is a better choice to prevent a change in smile. If there is excessive gum show, the optimal tip augmentation technique is a columella strut without tapering or even wider posterior end, with fixation of the columella strut to the septum, with or without extended spreader grafts which will push the upper lip caudally. The remaining scenarios are described in detail. Tip augmentation maneuvers in rhinoplasty can have a significant influence on upper lip position, which is often detrimental to the smile. The pre-operative position of the upper lip during smile should play an integral role in the selection of tip augmentation technique.

Functional evaluation of Septal L-strut extension graft in East Asians

BackgroundThe septal L-strut extension graft (SLEG) consists of anterior extended spreader graft and caudal septal extension graft. SLEG is used to increase the anterocaudal projection from a low-profile nose by creating the de-novo septum. This retrospective study verified the effectiveness of SLEG in improving the nasal function in East Asians. MaterialsMedical records of patients who underwent septorhinoplasty with SLEG were retrospectively reviewed. The clinical features showed under-projected lower two-thirds of the nose with septal deviation, saddle nose, and short nose. We analyzed the post-operative changes in the NOSE score and variables of nasal geometry measured using acoustic rhinometry through long-term follow-up. ResultsPatients were divided into two groups, those who underwent SLEG with turbinoplasty (Group A) and SLEG alone (group B). The NOSE scores decreased significantly in groups A and B, and the improvement was statistically more significant in Group A (p < 0.05). Acoustic rhinometry showed an increase in nasal cavity volume (VOL1) on the deviated side in Group A, and an increase in minimal cross-sectional area 1 (MCA1) on the deviated side in Group B (p < 0.05). The non-deviated side did not show significant reduction in MCA1 and VOL1 after SLEG with or without turbinoplasty. Thus, SLEG, by itself, improved airway function in East Asians. ConclusionsSLEG has proven to be valuable in improving nasal function.

Functional and esthetic outcomes of functional rhinoplasty for internal nasal valve dysfunction in Asian patients

ObjectiveThis study aimed to use validated measures to evaluate the functional and esthetic outcomes in patients who underwent functional rhinoplasty for Internal Nasal Valve Dysfunction (INVD) in Korea. MethodsA retrospective review of consecutive patients who underwent functional rhinoplasty for INVD confirmed by endoscopic findings and the modified Cottle test between 2016 and 2018 was performed. Nasal obstruction was assessed with the Visual Analog Scale (VAS) and nasal obstruction symptom evaluation (NOSE) scale. Acoustic rhinometry was performed pre- and post-operatively. The Minimal Cross-Sectional Area (MCA) of the nose was measured. Objective assessment of the esthetic outcomes was performed with the Objective Rhinoplasty Outcome Score (OROS), which assesses tip rotation, projection, width, dorsal height, width, length, symmetry, and the overall result. ResultsFifty-seven patients (46 men and 11 women; mean age, 30.5 ± 12.3 years) who underwent functional rhinoplasty were included in this study. The VAS and NOSE scores indicated functional improvement in all cases (all p < 0.001). There were no significant between-group differences (VAS score, p = 0.274; NOSE score, p = 0.952). The objective functional outcomes evaluated using MCA on the concave (p = 0.478) and convex (p = 0.631) sides did not differ significantly pre- and post-operatively. The subjective evaluation of esthetic satisfaction revealed no between-group difference. Moreover, 31 out of 44 patients (70.5%) with static INVD and nine out of 14 patients (64.3%) with dynamic or combined INVD showed excellent outcomes. Regarding objective esthetic outcomes, scores for the eight factors were >3, and there was no significant difference between the two groups (all p > 0.05). ConclusionsFunctional rhinoplasty, including extracorporeal septoplasty and spreader grafting, may be a viable option for correcting INVD with functional and esthetic improvement. Dynamic INVD is less prevalent among Asians, and there was no significant difference in the surgical outcomes compared with those of static INVD. Level of EvidenceLevel 4.

Effect of Dorsal Preservation Techniques on Septum Strength: An Experimental Animal Study.

This experimental animal model study investigates the impact of different methods employed in preservation rhinoplasty (PR) on the strength of the nasal roof, focusing on three techniques: high strip, low strip, and intermediate strip. Using 15 lamb heads as surgical models, the study addresses key questions related to the strengths of each PR techniques, the influence of septal cartilage harvesting on septum strength, and the effectiveness of spreader grafts for stability. The research involves detailed dissection steps and measurements at various nasal points, evaluating the resistance at each stage. Results indicate that the low strip technique demonstrates the most significant reduction in strength. Furthermore, the combination of PR techniques with structural grafts, specifically spreader grafts, is assessed, revealing the classical rectangular spreader graft to be more effective in stabilizing the dorsum. Despite the limitation of using the lamb heads as models, this study offers valuable insights into the effects of PR on nasal septum strength and provides a foundation for further research on the biomechanics of preservation techniques.

Aesthetic Outcomes of Rhinoplasty Performed in the Early Posttrauma Period after Nasal Bone Fracture.

The optimal timing of rhinoplasty for patients with nasal bone fractures remains controversial. We investigated whether the timing of rhinoplasty after nasal trauma affects the aesthetic outcome of the procedure. A total of 41 adult patients with nasal bone fractures who underwent rhinoplasty between 2006 and 2021 were enrolled in this study. A visual analog scale (VAS) was used to indicate the assessor's satisfaction with the surgical outcome after a comparison of the pre- and postoperative facial photographs of each patient. Of the 41 patients, 28 underwent rhinoplasty within 14 days after nasal trauma (early rhinoplasty group), whereas 13 underwent rhinoplasty more than 14 days after nasal trauma (late rhinoplasty group). The rate of receiving spreader and shield graft was higher in the late rhinoplasty group (p = 0.043 and 0.018, respectively). Patients with type IV or V nasal bone fracture and patients with preoperative saddle noses had higher VAS scores than those with types I to III fractures and those without preoperative saddle nose (p = 0.003 and 0.020, respectively). There was no significant difference in overall aesthetic outcome between the early and late rhinoplasty groups. Both groups achieved significantly better radix height, dorsal height, and tip projection after rhinoplasty. The aesthetic outcome of rhinoplasty performed in the early posttrauma period is comparable with that of rhinoplasty performed more than 2 weeks after nasal bone fracture. Rhinoplasty can be considered a safe surgical treatment option for nasal bone fracture, even in the early posttrauma period. LEVEL OF EVIDENCE: : 4.

Boomerang Modification of the Septal Extension Graft: Graft Design and Functional Outcomes.

Background: A "boomerang" graft is an end-to-end caudal septal extension graft (SEG) that conforms to the geometry of the anterior septal angle, and avoids septal overlap, unlike a side-to-side SEG. Objective: To compare breathing improvements in rhinoplasty patients receiving boomerang SEGs and patients receiving side-to-side SEGs. Methods: Retrospective cohort analysis of patients undergoing rhinoplasty with either end-to-end boomerang SEG or a side-to-side SEG. Functional outcomes were assessed through the Nasal Obstruction Symptom Evaluation (NOSE) survey. Results: The boomerang SEG cohort had a mean age of 34 years and were 68% female compared with 38 years and 67% female in the side-to-side SEG cohort (p > 0.05). The cohorts did not differ in the proportion of the lateral crural tensioning, spreader graft placement, or history of rhinoplasty. The boomerang cohort demonstrated a 67% reduction in NOSE scores compared with a 70% reduction among the side-to-side SEG cohort (p = 0.14). Men undergoing boomerang graft placement reported significantly less postoperative functional improvement than men undergoing placement of a side-to-side SEG (62% vs. 77%, p = 0.01). Conclusion: Use of a boomerang graft is not likely to negatively affect rhinoplasty functional outcomes when compared with a side-to-side SEG.

Nasal Patency Measurement: State of the Art of Acoustic Rhinometry.

Nasal obstruction is one of the main symptoms of different nasal pathologies. Many physiological and pathological conditions can produce nasal airflow impairment causing nasal obstruction and affecting patients' quality of life. There are different methods for the measurement of nasal obstruction, but in clinical practice the most common used are acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flow. This review describes the fundamentals of acoustic rhinometry, its normal values, the different physiological and pathological conditions that can modify nasal patency, and the utility of this instrument for the measurement of nasal obstruction in clinical practice. Acoustic rhinometry is a simple test, so it is suitable for measurements in the pediatric population, i.e., for evaluating adenoid hypertrophy. Acoustic rhinometry normal values are available, unilaterally and bilaterally for pediatric and adult populations. Acoustic rhinometry has been demonstrated to be reproducible and even superior to rhinomanometry when measuring nasal modifications during challenges. It is possible to use acoustic rhinometry before and after nasal surgery. Measuring nasal cavities volume and cross-sectional area, acoustic rhinometry is particularly indicated in rhinosurgery, especially for the evaluation of spreader grafts. Brief considerations about the correlation between nasal symptoms, in particular the subjective sensation of nasal obstruction, and the acoustic rhinometry results as well as the correlation of acoustic rhinometry with other methods for the measurement of nasal obstruction are also reported. Objective and subjective evaluation of nasal obstruction gives different information that together optimizes the diagnosis and the treatment of rhinologic patients. Acoustic rhinometry alone or in combination of other instruments for the measurement of nasal obstruction or patency should be used regularly in every outpatient clinic that treats patients with nasal obstruction as there is an increasing need of evidence-based therapies.

The Use of a Unilateral Curved Spreader Graft in the Management of Crooked Nose Deformity.

The aim of this study is to present a new technique of using spreader grafts in the correction of crooked nose deformity with C-shaped deviation of the middle third of the nose. This is a prospective case series study conducted on 18 patients with crooked nose deformity with C-shaped deviation of the middle third of the nose. All of the patients were managed by open septorhinoplasty. During surgery, a curved spreader graft was harvested from the nasal septum and placed on the convex side of the C-shaped deviation of the dorsal part of the nasal septum. Objective measurements of the angles of external nasal deviation (END) and the internal nasal valve (INV) angles were performed before and 6 months after the surgery. Subjective assessment of aesthetic satisfaction by the visual analog scale and nasal function by the nasal obstruction symptom evaluation scale was also performed before and 6 months after surgery. Eighteen patients were enrolled in the study and completed the minimum follow-up period of 6 months. The mean follow-up period was 17.3 months. Objectively, there was highly significant ( P < 0.00001) improvement of the END angle and INV angle. Subjectively, there was also highly significant ( P < 0.00001) improvement of both the nasal obstruction symptom evaluation score and the visual analog scale score for aesthetic satisfaction. The insertion of a curved unilateral spreader graft over the convexity of the deviated nasal dorsum can correct the END, improve the collapsed INV on both sides, and consequently achieve satisfactory aesthetic and functional outcomes.

Aesthetic and Functional Consequences of Spreader Graft without Suturing To the Upper Lateral Nasal Cartilage: A Randomized Double-Blinded Clinical Trial.

Considering the importance of the spreader graft technique in order to prevent collapse and airway retention and the importance of its effect on the dorsal aesthetic line and nasal width, in this study we compared the outcome of suturing spreader graft to septum _upper lateral cartilageas the classic technique to suturing spreader graft only to septum. This comparative observational study was conducted on 50 consecutive patients referred to Rhinoplasty Department in 15 khordad Hospital from 2019 - 2020 . The study participants were randomly assigned into two groups which scheduling the new spreader graft technique without suturing the upper lateral cartilage (n = 25) or the frequent spreader graft technique with suturing to both septum and upper lateral nasal cartilage (n = 25). The nasal obstruction degree, the status and health-related quality of life, patients' satisfaction, and subjective mental image of the nasal structure were the study endpoint. The patients were followed-up for six months. The two groups were matched for gender and age. Although all study endpoints significantly improved in both groups, but the six-month trend of the change in each parameter was different in the two groups with superior improvement in those who planned for spreader graft technique without suturing the upper lateral cartilage. In patients scheduling for selective rhinoplasty, new procedural technique including spreader graft without suturing to upper lateral cartilage can lead to more postoperative favorable outcome with regard to patients' satisfaction of the procedure, lack of obstructive symptoms, aesthetic feature, and health-related quality of life as compared to suturing to both septum and upper lateral cartilage.

Step by Step of a Creative Template for Rhinoplasty Training in Chicken Breast

Introduction: Rhinoplasty is a challenging surgery and provides balance, harmony, and symmetry to the face, so it should always be following the exact measurements and plan. Variations in techniques, measurements, and photographic studies have represented the surgeon's work tripod to optimize the aesthetic and functional results of nasal surgery. Furthermore, the creative template for rhinoplasty training will provide the young surgeons improve their practice and develop manual skills. Objectives: To demonstrate the rhinoplasty surgical sequence in a cadaveric animal (chicken) with an objective, systematic, and reproducible way for training the young surgeons. To establish grafts measurements in a clear, readable, and effective way. Casuistic and Method: This research is a prospective study for training the rhinoplasty technique in a cadaveric animal (chicken). The systematization of the surgical sequence in the animal model manufacture grafts for rhinoplasty in an objective way to simulate the nose. The breasts of cadaveric chickens coated with leather were selected and treated in the laboratory in São Paulo, Brazil. The models were photographed and filmed to record the stages of the grafts creation, such as spreader graft, columellar strut graft, shield graft, onlay graft, septal extension graft, alar batten graft, lateral strut graft, alar rim graft, free diced cartilage, combined graft, cap graft, and pump graft. The surgical materials are the same used in rhinoplasty, only in a small amount. Result: Surgical simulation model chicken sternal cartilage provides enough cartilage to practice rhinoplasty sculpting without involving live humans or human cadavers. The cartilage is abundant and properly to simulate the nose. The creative template is a clear, legible, and effective training of rhinoplasty grafts in an animal model. Conclusion: This article provides possibilities for training, creating grafts, and developing rhinoplasty techniques with the chicken breast cartilage. The creative template application shows an objective, clear, and systematic manner of learning without fear the beauty of the rhinoplasty art. This study is specially designed for young surgeons with a very low cost, artistry, and a reproducible way. No competing financial interests exist. No funding was received for this article. Runtime of video: 6 mins 44 secs

Applied surgical methods and outcomes in crooked nose rhinoplasty.

In this retrospective and multicentric study, we investigated applied surgical methods in rhinoplasty for crooked nose deformity. The retrospective data for 300 crooked nose deformity cases (191 males and 109 females) were used in our study. Classification of the initial deformities was performed as (1) I-shaped crooked nose deformity, (2) C-shaped crooked nose deformity, (3) Reverse C-shaped crooked nose deformity, and (4) S-shaped crooked nose deformity. As an operation technique, L-strut septoplasty was performed. The applied surgical methods in rhinoplasty to correct the crooked nose are evaluated and classified. Our results showed that initial deformities in crooked nose patients were I-shaped crooked nose deformity (34%), C-shaped crooked nose deformity (28%), Reverse C-shaped crooked nose deformity (21.3%), and S-shaped crooked nose deformity (16.7%). L-strut septoplasty was performed, and the results of the applied methods to correct the crooked nose were evaluated and classified. It was noticed that more than one procedure was applied to each case: (1) double-side lateral osteotomy (86.6%), (2) wedge bone resection on one side of the osteotomy (7.3%), (3) single-side lateral osteotomy (6%), (4) symmetric spreader grafts (56%), (5) asymmetric spreader grafts (10.6%), (6) shaving of the transverse wing of dorsal septum (8%), (7) correction of deviated dorsal septum (16.3%), (8) displaced anterior nasal spine (12.6%), (9) clocking suture (dorsal septal rotation suture) (9%), (10) dorsal septal scoring and splinting graft (8.3%), and equalizing lateral cruses (12.6%). I-shaped and C-shaped crooked nose deformities were mainly detected in crooked nose deformity patients. Correcting the crooked nose, double-side lateral osteotomy, and symmetric spreader grafts were the most applied techniques to correct the crooked nose. Other rhinoplasty techniques were also applied to these patients; more than one technique was needed.

Efficiency of Middle Vault Reconstruction with Dorsal Septal T Flap in Achieving Ideal Dorsal Aesthetic Lines and Regularity.

Dorsal aesthetic lines and irregularities are the most critical points that can be manipulated in rhinoplasty operations. Although spreader grafts and flaps have been used for this purpose in the reconstruction of the keystone area for a long time, dorsal irregularity is often inevitable. This study aims to evaluate the effectiveness of dorsal septal T flap and nasal dorsum reconstruction in achieving ideal dorsal aesthetic lines and regularity. Thirty-four patients (30 women, 4 men) who underwent closed technique rhinoplasty between 2019 and 2021 were included in the study. The mean age of the patients was 25.4 years. Patients with crooked nose, severe deviation, and severe dorsal hump were also excluded. All patients included in the study underwent Rhinoplasty Outcome Evaluation (ROE) questionnaires preoperative and postoperative 1st year. The mean age of the patients was 25.4 years (range 18-40years). A total of 34 patients, including 30 women and four men, were operated. The mean follow-up period was 13.2 months, ranging from 12 to 14months. In the physical examinations performed at the control visits, no functional problem was encountered in any patients. Preoperative and postoperative mean ROE scores were 60.9 and 92.7, respectively. With the technique described in the study, dorsal hump recurrence is minimized compared to other preservation techniques. Since the keystone area transition can be fine-tuned, continuity is ensured, and ideal dorsal aesthetic lines are created. The stability of the upper lateral cartilages is provided, thus eliminating the need for spreader grafts. 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 .

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 .

Olfactory drug delivery with intranasal sprays after nasal midvault reconstruction

Conductive olfaction and nose to brain drug delivery are important processes that remain limited by inadequate odorant or drug delivery to the olfactory airspace. Primary challenges include anatomic barriers and poor targeting to the olfactory region. This study uses computational fluid dynamics to investigate the effects of nasal midvault surgery on olfactory drug delivery with intranasal sprays. Soft tissue elevation, spreader flaps, and spreader grafts were performed on two fresh cadaveric specimens, using computed tomography for airway reconstruction. Nasal airflow and drug particle transport simulations were performed under these conditions: inhalation rate (15, 30 L/min), spray velocity (1, 5, 10 m/s), spray location (top, bottom, center, medial, lateral), head position (upright, supine, forward, backward), and particle size (1–100 µm). Simulation results were used to calculate drug particle deposition to the olfactory airspaces and bulbs. Total olfactory deposition was < 5% but attained a maximum of 36.33% when sorted by particle size. There was no association between nasal midvault surgery and olfactory deposition. No single parameter or technique demonstrated superior olfactory deposition, but smaller particle size, slower spray velocity, and higher inhalation rate tended to optimize olfactory deposition, providing important implications for future intranasal spray and drug design to target the olfactory airspace.