Spreader graft placement: a simplified technique for young surgeons

Functional and aesthetic outcomes of spreader graft and auto-spreader flap after nasal hump removal

Background

Following the reduction of the nasal hump to a desired level, spreader grafts are usually positioned to prevent the complication of nasal valve collapse. Auto-spreader flap is a new technique that gained more popularity recently and can be used as an alternative to spreader graft. This RCCT compared between both techniques aesthetically and functionally as well as the operative time.

Results

Forty patients, 17 males (42.5%) and 23 females (57.5%), were included. The mean duration of operation in auto-spreader flap was 11.8 ± 3.4 min, while it was 19.2 ± 3.2 min in spreader graft. The difference between the two procedures was statistically significant (P < 0.05). Functional assessment of nasal obstruction was done for all patients in both groups preoperative that was (75.6 ± 19.9) which showed marked improvement when re-evaluated 3 moths postoperatively (18.9 ± 14.7), and after 6 months NOSE scale was (29.1 ± 20.2). The overall aesthetic satisfaction was 62.5% (25 of 40) irrespective of the surgery done. Sixteen out of 20 patients in spreader group and 9 out of 20 in auto-spreader flap group.

Conclusion

Auto-spreader flap and spreader graft are very effective surgical procedure for treatment of nasal obstruction due to internal nasal valve dysfunction, but the auto-spreader flap had shorter operative time. However, spreader graft has a superior aesthetic outcome.

Spreader Graft Easy and Stable Fixation

The original spreader graft described by Sheen was dissecting a sub perichondrial flap along the anterior edge of the septum and inserting the grafts in place and occasionally, fixing them with a mattress suture. Although it has been done usually with mattress suture, it has some disadvantages as the instability of the graft while it is being fixated and others. We present a different fixation method with a simple running suture instead.

Early Results and Description of a New Modification of Spreader Graft to Enlarge Nasal Valve Area: Modified Triangular Spreader Graft

OBJECTIVE

Nasal valve area is an important, functional part of nose and there are several different methods that have been used to enlarge that area for a better breathing function. In this study, the authors aimed to study the efficacy of a new spreader graft modification that was crafted in a triangular shape to enlarge nasal valve area.

METHODS

Twenty-two patients who underwent rhinoplasty operation with this new technique composed the study group. Average age of patients was 21.4 ± 2.1, 13 of them were men (59%) and 9 of them were women (41%). Same surgeon operated all 22 patients with the same technique that included usage of modified triangular spreader graft. Surgical outcomes were assessed by visual analog scale and nasal obstruction symptom evaluation scale preoperatively and 3 months postoperatively.

RESULTS

None of the patients had complications or aesthetic deformities according to surgeon after surgery. Average of nasal obstruction symptom evaluation scale score was 64.3 before surgery which reduced to 17.9 at postoperative third month. Also average visual analog scale score was 2.6 before surgery and it was 8.1 3 months after surgery indicating a better breathing sensation (P < 0.001).

CONCLUSIONS

Modified triangular spreader graft usage is a safe and effective method to enlarge nasal valve area with satisfactory aesthetic outcomes and good functional results because of its compatibility with anatomic position of nasal valve area.

Do the Size and Extension of the External Nasal Splint Have an Effect on the Osteotomy, Brow Lines, and Long-Term Results of Rhinoplasty: A Prospective Randomized Controlled Trial of 2 Methods

PURPOSE

While performing a lateral nasal wall osteotomy during a rhinoplasty, an intentional fracture is produced and the fractured segments are medialized to narrow a wide nasal base. The purpose of this study was to investigate the effect of size, shape, and extension of the external nasal splint on the osteotomy, brow lines, and long-term results of rhinoplasty.

MATERIALS AND METHODS

The authors designed a randomized prospective clinical trial. The study population was composed entirely of patients who were voluntarily referred to the authors' department from May 2012 to May 2013. They were randomly divided into 2 equal groups. The primary predictor variable was splint type. For group 1, the external splint was extended beyond the osteotomy lines laterally and covered the overlying skin of the frontal process of the maxillary bone. For group 2, the external splint was trimmed above the osteotomy lines. The primary outcome variables were the levels of satisfaction with the dorsal esthetic lines, brow lines, and distinct osteotomy lines at 12 months after the operation. Demographic variables were gender and age. Mann-Whitney U test, χ(2) test, and t test were used to analyze the data. Results with a P value less than .05 were considered significant.

RESULTS

Forty healthy patients (American Society of Anesthesiologists status I and II; 18 men and 22 women; age range, 19 to 41 yr; mean, 31.4 yr) were selected. Although the level of satisfaction with the dorsal esthetic lines was higher in group 2, it was not significantly different from group 1 (P > .05). The levels of satisfaction with the brow lines and the distinct osteotomy lines were significantly higher in group 2 (P < .05).

CONCLUSION

The results of this study showed that when a nasal splint is extended beyond the frontal process of the maxilla rather than the base of the nasal bones, positioning of the bones and long-term results are unpredictable.

The accordion suture technique: A modified rhinoplasty spreader flap

In rhinoplasties, a spreader flap is a widely used alternative to dorsal reconstruction with spreader grafts; however, it has a limited ability to provide sufficient nasal dorsal width. The upper lateral cartilage (ULC) thickness is four times thinner than a spreader graft. This report presents an accordion suture technique for the ULC that involves simple sutures which fix each ULC (3 times folded) to the septum. We performed this technique in 64 primary rhinoplasties, and the patients were followed up for approximately 18 months. The patients completed a questionnaire 12 months postoperatively, and reported marked satisfaction with the aesthetics and function. Furthermore, rhinomanometric analysis showed that nasal airway resistance (NAR) decreased significantly in the postoperative period.