30 May What are spreader grafts? Dr Grigoryants Reviews Spreader graft use in rhinoplasty
Review of Spreader Grafts by Dr. Vladimir Grigoryants
Spreader grafts are frequently used in rhinoplasty. Spreader grafts are strips cartilage made of patients own cartilage that are placed on each side of the septum ( between the septum and the side wall). Typically, the mid or lower portion of the septum is harvested to make spreader grafts. Other synthetic materials or other sources of cartilage (e.g ear cartilage) can also be used for spreader grafts. I prefers to use patient’s own septal cartilage to make the spreader grafts.
1. Why are spreader grafts needed?
Spreader grafts are very important to prevent midnasal collapse (also known as an internal nasal valve collapse or inverted V deformity).
The dorsal aspect of the septum (the top or the bridge) is naturally wider than the portion below it, looking like a letter T. The wider part of the T holds the side walls apart. This is the internal nasal valve. When the dorsal hump is removed that wide portion of the septum (horizontal part of the T) is removed in most cases leaving the narrow portion of the septum, looking like an letter I. Without reconstructing that wide portion of the dorsal septum, the side walls will invariably collapse causing nasal valve obstruction (breathing obstruction) and cosmetically collapsed nose, called an inverted V deformity. Therefore, in nearly all cases, when dorsal hump reduction is performed, spreader grafts should be used to prevent the sidewalls from collapsing. In some patients, with or without the dorsal hump, the wider portion of the T is naturally narrow causing nasal valve collapse on inspiration. Spreader grafts are used to reconstruct the internal nasal valve and improve nasal airway patency in these patients.
Furthermore, the spreader grafts also used close the open roof following dorsal hump reduction. Click on the diagram above to enlarge it.
So, spreader grafts support the sidewalls, preventing them from collapsing and maintaining or improving the internal nasal valve. Aesthetically, spreader grafts allow to produce smoother nasal contour line from the forehead to the tip on the front view, knows as dorsal aesthetic lines. The spreader grafts are not visible as they are placed between the septum and the lateral walls.
Please google Inverted V deformity in Google images to see what an Inverted V deformity looks like when spreader grafts are not used.
2. Will spreader grafts make the nose wider following dorsal hump reduction?
Patients with a wide dorsum (bridge) will have narrower noses following dorsal hump reduction, spreader graft placement and nasal bone narrowing via osteotomies.
Those patients with a narrow midportion of the bridge preoperatively will have a slightly wider midportion of the nose after spreader graft placement, which would be aesthetically more appropriate and better functionally.
Patients with an average dorsal width of about 7 -12mm will usually have about the same width after surgery as before surgery. It is possible for the width of the midnasal area to be slightly wider after surgery if the nose is significantly deviated and additional spreader grafts are needed to keep the nose straight.
It is very important to note that even 12 months after rhinoplasty there is still a small amount of swelling that takes years to go away. So, the nose may initially appear wider and continue to narrow during the first several years.
This patient underwent rhinoplasty almost three years ago. Her dorsal hump was removed and the tip and nasal bones were narrowed. Spreader grafts, septoplasty and turbinate reduction were performed to treat nasal airway obstruction. The bridge/midnasal area and tip appeared wide preoperatively. Spreader grafts allowed to produce smooth dorsal aesthetic lines (lines from the forehead to the tip on each side of the dorsum) and prevent nasal wall collapse. The midnasal area is narrower postoperatively.