PURPOSE: Spreader grafts technique is recognized and widely employed in rhinoplasty for middle nasal vault reconstruction. The purpose of this study is to describe this method and analyze the functional and aesthetic effects of its application.
MATERIAL AND METHODS: Autologous or alloplastic sticks with individually designed measurements were submucoperichondrially implanted between the frontmost parts of anterior septal edge and upper lateral cartilages. This technique was applied in 36 patients with different indications for middle nasal vault reconstruction. Of them, 26 underwent primary and 10 - secondary rhinoplasties. Open approach was used in 32 patients but endonasal one in the rest four patients only.
RESULTS: We present our recent clinical material when using the spreader grafts technique. These grafts help to achieve harmonious dorsal aesthetic lines, internal nasal valve competence preservation or recreation, and maintenance of the straightened position of the corrected deviated cartilaginous septal dorsum.
CONCLUSION: Though the spreader grafts technique is the solution of choice in many cases, particularly in secondary rhinoplasties, it is neither universal, nor perfect. There is uninterrupted debate on its true value in nasal patency. The result depends considerably on the surgeon`s technical skills and precision. Based on the literature available and our own experience, we could conclude that the spreader grafts technique in rhinoplasty presents with both positive and negative patterns.
Andre, R. F., S. H. Paun, H. D. Vuyk. Endonasal spreader graft placement as treatment for internal nasal valve insufficiency: no need to divide the upper lateral cartilage from the septum. Arch. Facial Plast. Surg. 2004; 6(1): 240-243.
Becker, D. G., S. S. Becker. Treatment of nasal obstruction from nasal valve collapse with alar batten grafts. J. Long Term EV Med. Implants, 2003;13(3): 259-269.
Byrd, H. S., R. A. Meade, D. L. Gonyon. Using the autospreader flap in primary rhinoplasty. Plast. Reconstr. Surg., 2007;119(6): 1897-1902.
Faris, C., E. Koury, P. Kothari, A. Frosh. Functional rhinoplasty with batten and spreader grafts for correction of internal nasal valve incompetence. Rhinology, 2006;44(2): 114-117.
Gruber, R. P., E. Park, J. Newman, L. Berkowitz, R. Oneal. The spreader flap in primary rhinoplasty. Plast. Reconstr. Surg., 2007;119(6): 1903-1910.
Gürlek, A., M. Celik, A. Fariz, A. Ersöz-Oztürk, A. T. Eren, G. Tenekeci. The use of high-density porous polyethylene as a custom-made nasal spreader graft. Aesthet. Plast. Surg., 2006;30(1): 414-416.
Ingels, K. J., K. S. Orhan, N. van Heerbeek. The effect of spreader grafts on nasal dorsal width in patients with nasal valve insufficiency. Arch. Facial Plast. Surg., 2008;10(5): 354-356.
Mendelsohn, M. Straightening the crooked middle third of the nose: using porous
polyethylene extended spreader grafts. Arch. Facial Plast. Surg., 2005;7(2): 74-80.
Murrell, G. L. Auricular cartilage grafts and nasal surgery. Laryngoscope, 2004;114(12): 2092-2102.
Nyte, C. P. Hyaluronic acid spreader-graft injection for internal nasal valve collapse. Ear Nose Throat J., 2007;86(5): 272-273.
Nyte, C. P. Spreader graft injection with calcium hydroxylapatite: a nonsurgical technique for internal nasal valve collapse. Laryngoscope, 2006;116(7): 1291-1292.
Oneal, R. M., R. L. Berkowitz. Upper lateral cartilage spreader flaps in rhinoplasty. Aesthet. Surg. J., 1998;18(5): 370-371.
Reiffel, A. J., K. J. Cross, H. M. Spinelli. Nasal spreader grafts: a comparison of Medpor to autologous tissue reconstruction. Ann. Plast. Surg., 2011;66(1): 24-28.
Rhee, J. S., J. M. Arganbright, B. J. McMullin, M. Hannley. Evidence supporting functional rhinoplasty or nasal valve repair: a 25-year systematic review. Otolaryngol. Head Neck Surg., 2008;139(1): 10-20.
Sheen, J. H. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast. Reconstr. Surg., 1984;73(2): 230-239.
Tastan, E., M. Demirci, E. Aydin, F. Aydogan, K. C. Kazikdas, M. Kurkcuoglu, et al. A novel method for internal nasal valve reconstruction: H-graft technique. Laryngoscope., 2011;121(3): 480-486.
Toriumi, D. M. Management of the middle nasal vault. Operat. Tech. Plast. Reconstr. Surg., 1995;2(1): 16-30.
Toriumi, D. M., J. Josen, M. Weinberger, M. E. Tardy, Jr. Use of alar batten grafts for correction of nasal valve collapse. Arch. Otolaryngol. Head Neck Surg., 1997;123(8): 802-808.
Yankov, D. V. Surgical treatment of the nasal osseo-cartilaginous vault deformities. PhD thesis. Varna, 2012, 112 p. (in Bulgarian).