The functional and aesthetic values of spreader graft technique in rhinoplasty

Abstract

Spreader grafts was first described by sheen in 1984 as a method of reconstructing the internal nasal valve and/or recontouring the aesthetic appearance of the nasal dorsum in cases of primary and secondary rhinoplasty One of the most important anatomical concerns when discussing the subject of the spreader grafts in rhinoplasty is the internal nasal valve which significantly regulates nasal airflow and resistance and it’s the major flow-resistive segment of the airway, contributing about half of all resistance. Before thinking to use the spreader grafts in any case of rhinoplasty a detailed assessment of the nasal esthetics as well as the function should be carried out. This can be done through a series of methods from the history taking, external nasal examination to multiple assessing tools such as the radiologic studies, endoscopic examination, rhinomanometry and acoustic rhinometry. Several grafting sources are described, however the most utilized graft source for the spreader graft is the septal cartilage. this could be difficult in cases of revision rhinoplasty where the septal cartilage might be deficient from previous operation, in which case the conchal or costal cartilage may be used instead. As the spreader graft acts as a spacer between the ULC and the septum they are indicated for several reasons in rhinoplasty; internal nasal valve obstruction or structural weakness, also for prevention of the complication of nasal valve collapse after hump removal in cases of humpy nose, reconstruction of the deviated nose along with lateral and medial osteotomies and also for the reconstruction and prevention of certain cases of saddled nasal dorsum deformity.

This study is mainly concerned with the assessment of the functional and esthetic outcome of the spreader graft when implicated in certain cases of rhinoplasty via a meta-analysis which showed that the use of spreader grafts in rhinoplasty can improve the functional outcome via preservation and restoration of the internal nasal valve angle and supporting its structural stability as well as the esthetic outcome as they serve to create aesthetic dorsal lines and through adequate correction of the cartilaginous crooked nose which indicates that the spreader graft is a valuable technique in the hands of the rhinoplasty surgeon specially after the proper selection of the patients depending on a delicate pre-operative assessment. Also the need for randomized controlled studies for the assessment of functional and esthetic values of spreader grafts in certain cases of rhinoplasty with standardized methods of assessment of this outcome remain among the valuable data that this study revealed.