Spreader Grafts Research Articles

A new approach for crooked nose: Separated spreader graft “puzzle graft”

IntroductionThe nasal septum takes an important role in nasal shape and function. The term “crooked nose” is commonly used for all of the clinical conditions involving deviation of the nasal axis from the midline. This situation leads to both aesthetic concerns and breathing problems. In this study, we describe a new method in order to nasal dorsum on the midline and improving airway function in crooked nose patients, that will be contribute to the literature. Materials and methodsThis study enrolled 50 (fifty) patients who had undergone open septorhinoplasty operation were included in our study. The puzzle graft, which was prepared as a spreader graft consisting of three separate parts, was used to correct crooked nose in all patients. Anterior rhinoscopic examination, photographs and Nasal Obstruction and Septoplasty Effectiveness (NOSE) scores for the pre-operative and post-operative 1 year were compared and evaluated in this study. ResultsThe new approach was used successfully in all of the patients. Anterior rhinoscopic and 1 year photographic evaluations revealed a significantly correction of external appearance post-operatively. None of the patients had any additional complaints and complications during the post-operative period. We observed that NOSE scores, with which the post-operative nasal obstruction was evaluated, were significantly better in all 50 patients. ConclusionCrooked nose deformity is one of the most difficult problems in rhinoplasty. There is no absolute true technique for solving this situation. Each method works properly in appropriate cases. Sometimes we should use more than one technique in the same operation to correct the pathology. Our purpose is to present a new option to help surgeons in “crooked nose”; to provide a new method that can work safe and effective in convenient conditions.

Assessment of Functional and Esthetic Outcomes of External Approach Septorhinoplasty with Spreader Graft in North India

Introduction: Rhinoplasty is one of the most commonly performed facial plastic surgeries. Esthetic rhinoplasty can be exclusively esthetic or for both functional and esthetic concerns combined. The spreader graft can be used as a spacer where a patient with nasal obstruction who is also having external nasal deformity can be benefitted in both the areas. Objectives: The objective is to assess the functional and esthetic outcomes pre- and post-operatively in patients undergoing external approach rhinoplasty with spreader grafting. Methodology: Thirty patients were included in the study. Internal valve collapse was confirmed by modified Cottle's maneuver and diagnostic nasal endoscopy. All surgeries were done using an external approach under general anesthesia. Pre- and post-operative nasal obstruction symptom evaluation (NOSE) and rhinoplasty outcome evaluation (ROE) score were taken. Results: The preoperative NOSE score average was 64.5. After 3 months of postoperative follow-up, the NOSE score reduced to a mean value of 11.83. The preoperative ROE score average was 6.73. Postoperative ROE score improved to a mean value of 18.83. Conclusion: Rhinoplasty is a delicate, skill demanding surgical procedure which, when done along with a spreader graft will be beneficial both functionally and cosmetically in patients with external nasal deformity with obstruction symptoms. Comparison of esthetic and functional results could be done further in future studies which will provide further inputs in the field of rhinoplasty.

Anatomic Optical Coherence Tomography (aOCT) for Evaluation of the Internal Nasal Valve.

To establish the utility of anatomic optical coherence tomography (aOCT) in evaluating internal nasal valve (INV). Anatomic specimen imaging study. Fresh-harvested human specimen heads were evaluated using both computed tomography (CT) imaging as well as using aOCT. Scans were performed at three time points: 1) After septoplasty for cartilage harvest, 2) after placement of butterfly graft (BFG), and 3) after placement of bilateral spreader grafts (SG). Imaging data were then converted into 3D models of the nasal airway. CT- and aOCT-generated models were compared by both static volumetric analysis and computational fluid dynamics (CFD) to predict nasal resistance and pressure. Scans using aOCT showed comparable results to CT in terms of volumetric parameters both before and after intervention. Analysis of aOCT data by CFD demonstrated decrease in pressure after SG or BFG intervention. No statistically significant difference was observed when comparing CT- and aOCT-generated calculations of pressure or resistance. The INV can be imaged in a static fashion using aOCT technology. Advantages over traditional CT imaging include lack of exposure to radiation and rapid scan time. In addition, in-office use is possible as aOCT technology develops. Further investigation will be necessary to define the role of aOCT in the dynamic evaluation of this vital component of the nasal airway. 3 Laryngoscope, 132:2148-2156, 2022.

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.

An Alternative Method for Midvault Restoration: "T-Splay Graft".

The internal nasal valve is one of the highly important anatomical points in rhinoplasty procedures. As a key anatomical area, the anatomical and functional integrity of this region must be preserved or reconstructed during rhinoplasty procedures. Several techniques have been defined in the literature for midvault restoration, among which, the most common are spreader grafts and flaps. Both techniques achieve a natural and harmonic contour but may fail to provide the splay effect to the upper lateral cartilages in some cases. A new technique known as the "T-splay graft", to be used as an alternative approach in cases where there is a risk of midvault collapse, and in which the splay effect in the upper lateral cartilage is preferred to be augmented, is explained in the present study. In the present study, a septal tunnel is opened of sufficient size for the cartilage graft planned for placement, at the planned level of the septum, to expand the midvault region and create a splay effect. A bilateral pocket is created in the inferior mucosa of the upper lateral cartilages. The harvested cartilage graft is passed through the septum in the horizontal plane. The cartilage graft is inserted into the bilateral pockets so as way to create convexity to the dorsum. As a result of the applied method, it was established that the internal nasal valve angle could be expanded to the desired extent and the dorsal aesthetic lines could be achieved in a normal anatomical structure. This technique enables the lateral direction of the tension between the graft and the upper lateral cartilages, and the creation of a splay effect. As such, we believe that this method is a highly effective alternative for use in appropriate cases. 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 .

The Impact of Upper Lateral Cartilage Release on Patient-Perceived Nasal Appearance and Obstruction.

Although upper lateral cartilages are commonly released from the dorsum of the septum during spreader graft placement in septorhinoplasty (SRP), there has been a focus on maintaining integrity of connections in the middle vault. Avoiding release of upper lateral cartilages in certain patient groups may represent an early step in this paradigm shift. We aim to assess satisfaction with nasal appearance and correction of nasal obstruction in patients who underwent SRP with spreader graft placement without upper lateral cartilage release and compared it to the traditional upper lateral cartilage release cohort. Prospective cohort study. A total of 559 patients who underwent SRP with spreader graft placement with upper lateral cartilage release and 30 patients who underwent SRP with spreader graft placement without release between 2012 and 2020 were administered the Nasal Obstruction Symptom Evaluation (NOSE), FACE-Q Satisfaction with Nose, and FACE-Q Social Functioning scales pre- and postoperatively. Pre- and postoperative NOSE FACE-Q, and negative inspiratory force (NIF) scores and changes were compared between groups. Results demonstrated clinically and statistically significant improvement at follow-up for both groups. There was no significant difference between groups in mean improvement of NOSE, FACE-Q, and NIF scores at time of last follow-up. SRP with spreader graft placement with and without upper lateral cartilage release provide clinically and statistically significant improvement, and no significant difference in functional outcome. This suggests that upper lateral cartilages do not need to be released to achieve functional improvement and that surgeons should consider whether release is necessary to achieve goals of surgery. 3 Laryngoscope, 132:1189-1195, 2022.

Does Full Transfixion Incision Decrease Tip Projection in Endonasal Septoplasty with Spreader Grafts?

The classic teaching is that full transfixion incision decreases nasal tip projection by disrupting the attachment of the medial crura to the caudal septum. A significant decrease in tip projection after endonasal septoplasty with spreader grafts through a full transfixion incision has not been identified at our institution. A retrospective cohort study was performed at our institution. Inclusion criteria consisted of patients undergoing endonasal septoplasty with spreader graft placement and available preoperative and one-year postoperative photos. Patients who had undergone an open approach, cosmetic rhinoplasty, had intercartilaginous incisions, or other procedures to affect tip projection were excluded. A query identified 432 patients, of which 104 patients met inclusion criteria. Of these, 19 had pre and post-operative photographs and were included in the final analysis. Mirror software was utilized to analyze the pre and post-operative photos for tip projection using the Goode method. The change in tip projection was analyzed from both left and right profile photos. The left change in nasal tip projection (or delta) was -0.010 (95% CI -0.003, -0.017) and the right delta was -0.013 (95% CI -0.005, -0.020). In our pilot study of 19 patients, we did not find a clinically significant change in nasal tip projection when a full transfixion incision was used for the approach. In our experience, full transfixion incision is a safe and effective method for improving functional status in patients without causing a significant change in nasal tip projection.

Invited Discussion on: "A Comparative Study of Isolated Osteotomies Versus Osteotomies with Spreader Graft Placement to Correct Primary Deviated Nose"

Invited Discussion on: "A Comparative Study of Isolated Osteotomies Versus Osteotomies with Spreader Graft Placement to Correct Primary Deviated Nose"

Efficacy of Polylactic-Co-Glycolic Acid Plate as a Graft Material in Septorhinoplasty

Background and Objectives Polylactic-co-glycolic acid (PLGA) plate has been recognized for its biocompatibility and biomechanical properties and used widely in various clinical fields. The aim of this study was to evaluate the usefulness and reliability of PLGA plate as a graft material in septorhinoplasty.Subjects and Method Medical records were retrospectively analyzed for patients who underwent septorhinoplasty including extracorporeal septoplasty from January 2017 to June 2020. We evaluated demographics, diagnosis, operation techniques, and complications of PLGA plate as a graft material used in these patients.Results A total of 33 patients were enrolled in this study. Twenty-eight were male and 5 were female. The median age was 32 years old. The follow-up period after surgery was 6-32 months, and the mean follow-up period was 18.03 months. The PLGA plate was used in unilateral spreader graft (n=17), bilateral spreader graft (n=10), batten graft (n=3), strengthening of septal extension graft (n=2) and columellar strut graft (n=3), and fixing L-strut during extracorporeal septoplasty (n=12). During the follow-up period, no patient experienced extrusion or exposure of the grafts. Mild complications, such as redness of the columella skin, granulation in the marginal incision site, and pain on the nasal dorsum were observed in three patients; these complications were temporary and patients improved with conservative treatments.Conclusion The PLGA plate may be a useful graft material in correcting deviated nose especially when the harvested septal cartilage is insufficient and if used carefully in limited locations such as L-strut and columella.

Comparative Effectiveness of Cartilage Grafts in Functional Rhinoplasty for Nasal Sidewall Collapse.

Objective: To compare the patient-reported outcomes among patients with nasal obstruction undergoing two rhinoplasty techniques to a control group. Methods: Prospective longitudinal study in a university-based tertiary care medical center. All patients undergoing functional septorhinoplasty for correction of lateral wall insufficiency between October 2015 and March 2019 were included; n = 704, mean age (standard deviation) 39.0 (15.4) years, 52.7% females. Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) and FACE-Q subscales pre- and postoperatively. Patients were divided into three cohorts: spreader and lateral crural strut (LCS) grafts (n = 141), spreader and alar rim (AR) grafts (n = 104), and the control spreader grafts alone (n = 218). Results: The median NOSE scores at last postoperative visit were improved from baseline (p < 0.001) for all cohorts. The FACE-Q nasal satisfaction median scores also improved postoperatively in all cohorts, AR, LCS, and spreader, respectively (p = 0.001, p < 0.001, and p < 0.0001). Conclusions: There was no detectable difference in the improved subjective nasal function, nor adverse aesthetic outcomes in the patients with lateral wall insufficiency treated with functional rhinoplasty techniques in this study.

Modified alar batten grafts for treatment in nasal valve dysfunction: Our experience

ObjectiveAlar batten grafts are used to treat in nasal valve dysfunction (NVD). They can be placed by open or closed rhinoplasty using rib, septal, or auricular concha cartilage. Our surgical team used a modified placement of the classic alar batten.We aim to describe these changes and to the technique and demonstrate that modified alar batten grafts can improve the effects of spreader grafts and classic alar batten grafts. MethodsA retrospective study of 91 functional rhinoplasties was performed from March 2011 to November 2019 at a public university hospital in Murcia. The patients were divided into three groups. Group A included patients operated on using spreader grafts, group B included patients operated on using spreader grafts associated with alar batten grafts fixed to the caudal edge of the lateral crura of the lower lateral cartilage (LLC), and group C included patients operated on using modified alar batten grafts. ResultsA total of 91 functional rhinoplasties were performed, 31 patients were operated on in group A, 27 patients were operated on in group B, and 33 patients were operated on in group C. The success rate was 67.7% in group A, 70.4% in group B and 93.9% in group C. ConclusionModified alar batten grafts achieved better results than spreader grafts and spreader grafts associated with classic alar batten grafts. The size, position and placement of the sutures of modified alar batten grafts were the key factors in improving our results.

A Comparative Study of Isolated Osteotomies Versus Osteotomies with Spreader Graft Placement to Correct Primary Deviated Nose.

It is a complete objective and subjective comparative study between two techniques of septorhinoplasty in patients undergoing primary rhinoplasty for crooked nose deformity. Forty patients having crooked nose deformity were randomly divided into 2 groups exhibiting two different techniques of correction. Patients were randomly divided into 2 group: Group 1: 20 patients underwent correction of crooked nose by performing bilateral triple osteotomies + Septoplasty Group 2: 20 patients underwent correction of crooked nose by performing bilateral triple osteotomies as well as placement of spreader grafts + Septoplasty Objective and subjective assessment of patients in preoperative and postoperative period was done by various scales and scores. Both the groups showed improvement in facial angles, ROE score, nasal airflow, and NOSE score. But, group 2 patients were more satisfied than group 1 patients in terms of both aesthetic appearance of nose and breathing function. It is very well known to the authors that aesthetic result of rhinoplasty is not just dependant on one technique. Keeping this in mind, we conclude that as group 2 patients were more satisfied with their overall results, the additional step of spreader graft placement helped these patients with the complaints associated with crooked nose deformity. However, we also emphasize that additional studies on larger numbers of patients should be performed to compare and know other intricacies of each technique that may play minor or major roles in deciding the success of each technique. 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 .

Extended L-shaped Spreader Graft for Correction of Combined Dorsal and Caudal Nasal Septal Deviations.

Summary:Although a wide range of surgical techniques have been proposed to straighten the deviated cartilaginous nasal dorsum and maximize nasal function, recurrence is common because of cartilage memory and scar contractures. An extended L-shaped spreader graft, a permanent support, was developed to correct functional and aesthetic problems, to prevent recurrence, and to maintain the correction of the septum stable and strong. This technique was utilized in 16 cases of deviated cartilaginous dorsum. All patients were subjected to a detailed history, physical examination, CT scan of the nose, and photographic documentation preoperatively. The patients were followed up during a period of 3 months to 4 years. According to physical examination, postoperative photography, and patients’ satisfaction, the final results were categorized as excellent, good, or poor. The results were as follows: 14 patients (87.5%) were classified as excellent, as their noses were completely straight, and this was consistent with physical examination and postoperative photographs. Two patients (12.5%) were classified as good because there was a minimal residual deviation according to either photographs or clinical examinations. This minimal deformity was not experienced by the patients. In conclusion, consistent, reproducible results were achieved with using the autologous extended L-shaped spreader graft for controlling and maintenance of the dorsal and caudal septal deviation after correction. It is one piece of L-shaped graft of autogenous cartilage fixed to the original septal L-strut. It is regarded as an anatomical graft that provides sustained cephalocaudal support, preserves pliability of the lobule, and maintains stability as an independent stabilizer for the native strut.

Spreader Graft Placement: An Effective Procedure for Alleviation of Internal Nasal Valve Collapse

The internal nasal valve (INV) is one of the most commonly involved areas in patients with nasal obstruction, and surgeries such as turbinate reduction and septal recontouring affect the physiology of the nasal valve area. With this concept, a cohort study was conducted to evaluate spreader graft's effectiveness in recontouring INV and relieving nasal obstruction. A prospective cohort study was performed, including patients with nasal obstruction with INV involvement. To quantify and compare the amount of nasal obstruction, Gertner Metal Plate (GMP) was used, and to assess the relief in associated symptoms, the Sino-Nasal Outcome Test (SNOT-22) was taken into consideration. GMP and SNOT 22 were performed preoperatively and postoperatively at the 1st, 3rd, and 6th months, and the data obtained were analyzed by SPSS 22 software using paired t-tests. The postoperative broadening of the nasal dorsum and patient satisfaction with the surgical outcome were also assessed using the visual analog scale . A total of 38 patients were included, with 28 males and 10 females. The data obtained were analyzed by using paired t-tests. Improvement in GMP assessment showed that t=10.392305, 13.391485, and 15.985243 at the 1st, 3rd, and 6th months, respectively, with an overall P ≤ .00001 and relief in associated symptoms assessed by SNOT 22 computed t=12.24228, 15.824486, and 18.046395 at the 1st, 3rd, and 6th month, respectively, with an overall P ≤ .00001. A total of 81.57% of patients did not perceive significant nasal dorsum broadening, and 86.84% of patients were highly satisfied by the surgical outcome based on the visual analog scale. We conclude that in patients with nasal obstruction associated with INV involvement, spreader grafting provides rapid relief of nasal obstruction and associated symptoms, does not cause any appreciable broadening, and provides a high degree of patient satisfaction. Hence, it should be preferred over septal recontouring and turbinate reduction.

Narrowing and Operated Appearance of the Middle Nasal Third after Hump Resection without Middle Vault Reconstruction.

Little is known about the incidence of narrowing and an operated appearance of the dorsum after hump resections if the dorsum is not reconstructed with spreader grafts or spreader flaps. Patients who had undergone a composite hump resection (n = 22) or a component hump resection (n = 25) were interviewed and photographed with a minimum follow-up of 12 months. Four expert rhinoplasty surgeons and four laypersons rated the appearance of the middle third of the dorsum on the preoperative and postoperative en face photographs. The quartile of the most surgical appearing outcomes was analyzed regarding potentially preventive surgical maneuvers. No patient was dissatisfied with the frontal view of the nose. Agreement between expert and lay raters (Kendall's coefficient of concordance) was 0.51 (p < 0.01) and 0.34 (p = 0.06) for appearance and 0.55 (p < 0.01) and 0.46 (p < 0.01) for width, respectively. Expert raters found that a surgical appearance of the dorsum had both increased and decreased after surgery, with an average increase of 0.27 ± 1.05 and 0.21 ± 1.18 points on a five-point Likert scale for composite and component resection, respectively. Pearson correlation between the degree of dorsal lowering and surgical appearance on the anterior view was 0.31 (p = 0.026). Reconstruction of the middle third could potentially have improved the outcome in 15 percent of the patients. Lowering of the dorsum without middle vault reconstruction on average increased an operated appearance to a small degree that was not noted by the patients. This effect was similar for composite and component hump resections. Therapeutic, III.

Rhinoplasty in the Older Adult.

Rhinoplasty in older adults requires unique consideration of the aging nose. The purpose of this study was to systematically review the literature pertaining to rhinoplasty in the aging population, review the senior author's experience, and describe techniques aimed at addressing age-related features. It was hypothesized that consistent age-related nasal dysmorphology is described in the literature and standard rhinoplasty techniques may effectively address these changes. Furthermore, it was hypothesized that rhinoplasty is more commonly performed for posttraumatic and functional indications than for aesthetic reasons. A literature review including publications describing rhinoplasty in patients over 55 years old was conducted. Additionally, a retrospective review of the senior author's cases was performed. Pre- and postoperative photographs were used to compare anthropometric changes. Demographic factors, surgical indications, and operative details were collected. Nine articles met the study criteria. Manifestations of the aging nose included soft tissue atrophy, bony fragility and resorption, tip ptosis, internal and external valve collapse, and worsening dorsal hump. Twenty-seven patients were included in this institutional review. Primary indication for rhinoplasty was posttraumatic deformity in 17 (63%) patients and nasal obstructive symptoms in 10 (37%) patients. Tip refinement and ptosis were addressed through tip grafts (70%), columellar struts (26%), and caudal septal extension grafts (67%). Nasal obstruction was relieved through septoplasty (96%), turbinate ablation (85%), and spreader grafts (70%). This study presents a systematic review of rhinoplasty in the older adult as well as a retrospective review of the senior author's patients. Unique considerations specific to this population should be integrated into treatment planning.

Significance of Inner Nasal Valve In Septoplasty

Background: Nasal obstruction due to deviated septum is commonly treated with conventional septoplasty. This surgery however is inadequate in cases of compromised nasal valves and leads to persistent symptoms. Hence, we stressed the evaluation of nasal valves before septal surgery &amp; studied the outcome of the patients with valve area correction. Aim: To prove the significance of inner nasal valve in nasal surgery. Objective : To analyse the outcome of Open septoplasty. Methodology:A retrospective review of our patients undergoing Open septoplasty was analysed from April 2016 to January 2021. The preoperative and post operative evaluations were calculated &amp; statistically analysed. Results : A total of 400 patients underwent Open septoplasty. Out of which 392(98%) showed symptomatic improvement in breathing difficulty &amp; 380(95%) were happy with the asthetic improvement. Conclusion: Open septoplasty and Spreader grafts is best solution to improve Internal Nasal valve angle. Rim graft to improve external valve collapse. Spreader graft also gives asthetic &amp; functional improvement

Application of septal extension graft with autogenous septal cartilage and auricular cartilage in rhinoplasty

Objective: To explore the feasibility of reconstruction of nasal tip with septal cartilage and auricular cartilage. Methods: From September 2018 to October 2019, 17 patients (two males and fifteen females) with low noses underwent rhinoplasty under general anesthesia. The age of the patients ranged from 19 to 39, with an average of 27 years old. Among them, all the 17 cases were primary rhinoplasty. During the operation, autologous nasal septum cartilage was used as septal extension graft to extend the caudal septum, and the auricular cartilage was used to enhance the stability of the strut and to elevate the tip for adjusting the shape of nose by making into spreader graft, columellar strut graft, derotation graft and onlay graft. The nasal dorsum was filled with polytetrafluoroethylene. Digital scanning technology was used to evaluate the nasal structure before and after operation. SPSS 22 software was used to analyze the data with paired t-test. Results: The follow-up was from 6 to 12 months, with an avaerge of 7.6 months. Seventeen patients were satisfied with postoperative nasal morphology and height. There was no infection, prosthesis displacement, skin flap necrosis, no auricle deformation and other complications. Statistical software SPSS 22 performed paired t-test on the preoperative and postoperative data obtained by digital technology: postoperative nasal length and nasal tip protrusion increased compared with that before surgery, and it was statistically significant(length:(3.60±0.77)mm, tip protrusion:(3.61±0.64)mm, t value was -19.203 and -23.132 respectively, both P<0.001). The nasolabial Angle was smaller than that before surgery, and the data were statistically significant(3.40°±2.11°,t=6.635, P<0.001). Conclusion: The nasal tip and nasal septum extension complex constructed by autogenous nasal septal cartilage combined with auricular cartilage can increase the length of nasal tip, increase the height of nasal tip and reduce the angle of nasolabial angle.

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.