The Use of Spreader Grafts or Spreader Flaps—or Not—in Hump Reduction Rhinoplasty

Abstract

Hump reduction is one of the most common reasons patients seek cosmetic rhinoplasty. Spreader grafts or spreader flaps have become a key maneuver in supporting and reconstructing the nasal midvault after reductive profileplasty to prevent long-term functional and cosmetic sequelae. This article reviews the pertinent anatomy, describes indications for spreader graft or spreader flap placement, discusses surgical techniques and approaches for spreader graft placement, and describes complications of spreader graft use after hump reduction.

Keywords

spreader graft - spreader flap - hump reduction

• References

• 1 Beekhuis GJ. Nasal obstruction after rhinoplasty: etiology, and techniques for correction. Laryngoscope 1976; 86 (04) 540-548
• 2 Courtiss EH, Goldwyn RM. The effects of nasal surgery on airflow. Plast Reconstr Surg 1983; 72 (01) 9-21
• 3 Grymer LF. Reduction rhinoplasty and nasal patency: change in the cross-sectional area of the nose evaluated by acoustic rhinometry. Laryngoscope 1995; 105 (4 Pt 1): 429-431
• 4 Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 1984; 73 (02) 230-239
• 5 Gonzalez JR, Winkler AA. The twisted nose: what to do when it's not straight. Facial Plast Surg 2018; 34 (03) 255-260
• 6 Rohrich RJ, Hollier LH. Use of spreader grafts in the external approach to rhinoplasty. Clin Plast Surg 1996; 23 (02) 255-262
• 7 Perkins SW. Primary rhinoplasty: Intermixed use of endonasal and external columellar approaches. In: Perkins SW. , ed. Rhinoplasty: Thomas Procedures in Facial Plastic Surgery. 1st ed. Shelton, CT: People's Medical Publishing House; 2012: 16-17
• 8 Gruber RP, Melkun ET, Woodward JF, Perkins SW. Dorsal reduction and spreader flaps. Aesthet Surg J 2011; 31 (04) 456-464
• 9 Saedi B, Amali A, Gharavis V, Yekta BG, Most SP. Spreader flaps do not change early functional outcomes in reduction rhinoplasty: a randomized control trial. Am J Rhinol Allergy 2014; 28 (01) 70-74
• 10 Yoo S, Most SP. Nasal airway preservation using the autospreader technique: analysis of outcomes using a disease-specific quality-of-life instrument. Arch Facial Plast Surg 2011; 13 (04) 231-233
• 11 André RF, Paun SH, Vuyk HD. Endonasal spreader graft placement as treatment for internal nasal valve insufficiency: no need to divide the upper lateral cartilages from the septum. Arch Facial Plast Surg 2004; 6 (01) 36-40
• 12 Wang L, Friedman O. Functional compromise in the middle vault in the management of revision rhinoplasty. Facial Plast Surg 2018; 34 (03) 239-244
• 13 Reiffel AJ, Cross KJ, Spinelli HM. Nasal spreader grafts: a comparison of Medpor to autologous tissue reconstruction. Ann Plast Surg 2011; 66 (01) 24-28
• 14 Yoo DB, Jen A. Endonasal placement of spreader grafts: experience in 41 consecutive patients. Arch Facial Plast Surg 2012; 14 (05) 318-322
• 15 Ingels KJ, Orhan KS, van Heerbeek N. The effect of spreader grafts on nasal dorsal width in patients with nasal valve insufficiency. Arch Facial Plast Surg 2008; 10 (05) 354-356
• 16 Faris C, Koury E, Kothari P, Frosh A. Functional rhinoplasty with batten and spreader grafts for correction of internal nasal valve incompetence. Rhinology 2006; 44 (02) 114-117
• 17 Fuller JC, Levesque PA, Lindsay RW. Analysis of patient-perceived nasal appearance evaluations following functional septorhinoplasty with spreader graft placement. JAMA Facial Plast Surg 2019;
• 18 Perkins SW, Hamilton MM, McDonald K. A successful 15-year experience in double-dome tip surgery via endonasal approach: nuances and pitfalls. Arch Facial Plast Surg 2001; 3 (03) 157-164