Assessment of Vertical Triangular Spreader Graft Technique for Reconstruction of Middle Vault and Internal Nasal Valve Angle

Abstract

Background: Rhinoplasty is a surgical procedure to smooth out the nasal deformities and to fix nasal breathing problems. Spreader grafts and flaps are used to prevent some complications such as middle vault collapse, narrowing the internal nasal valve and inverted V deformity. To obtain more stable middle vault, spreader grafts and flaps could be used together. Many researchers have tried different graft and flap techniques to reach more successful aesthetic and functional results. In this research, we investigated effects of triangular graft on the internal nasal valve angle, nasal breathing, and aesthetic outcomes when it used together with sprader flap. Methods: In this prospective study, 3 different groups were formed as: the spreader flap group (group 1); the spreader flap with the rectangular spreader graft group (group 2); and the spreader flap with the triangular spreader graft group (group 3). Preoperative nasal obstruction symptom evaluation (NOSE) scale was used to evaluate nasal breathing and visual analog scale (VAS) was used to evaluate aesthetic appearance. And also, measurement of the internal nasal valve angle was performed for each patients. These evaluations were repeated at postoperative 3rd month. Preoperative and postoperative comparisons between study groups were performed. Results: There were 12 patients in group 1, 14 patients in group 2, and 10 patients in group 3. In each group, statistically significant decrease in NOSE scores (P < 0.05) and statistical significant increase in VAS scores (P < 0.05) were observed. And also, increased internal nasal valve angle after surgery was detected in all groups (P < 0.05). Postoperative NOSE and VAS scores were found similar in 3 different groups (P > 0.05). On the contrary, the internal nasal valve angles were found statistically significant increased in group 3 according to other groups (P < 0.05). Conclusion: The results of this prospective study presented that the use of triangular spreader graft with spreader flap was an appropriate technique to obtain successful aesthetic and functional outcomes with widening the internal nasal valve angle.

Role of spreader flaps in primary rhinoplasty, functional and aesthetic outcomes: a systematic review

“…Hussein et al (14) presented an increase of the angle postoperatively without mentioning the level of statistical significance. Kocak et al (22) presented a statistically significant increase in the nasal valve angle postoperatively in all three study groups (p=0.00). Although, the highest postoperative improvement was observed in the SF group with triangular SG (p=0.001).…”

“…Particularly, Yoo et al (18) presented a significant BFI in the group with nasal obstruction (p<0.001). In the Κocak et al study (22) , a significant reduction in the NOSE score was observed in the SF group and in the SF group with triangular SG (p=0.05). There was no significant postoperative difference between the study's groups (p=0.695).…”

“…Specifically, all studies noted an improvement in breathing function. However, this improvement was statistically significant in six (12,15,18,(21)(22)(23) of the eight studies (12,14,15,16,18,(21)(22)(23) .…”

“…In the Hussein et al (14) and Kocak et al (22) studies, the angle of the nasal valve was evaluated pre-or intra-and postoperatively by endoscopic images. Adobe Photoshop was used to calculate the angles.…”

“…The NOSE questionnaire was used as one of the basic subjective methods for evaluating BFI in eight (12,14,15,16,18,(21)(22)(23) of the 13 studies (12)(13)(14)(15)(16)(18)(19)(20)(21)(22)(23)(24)(25) . Specifically, all studies noted an improvement in breathing function.…”