Rebuilding the Middle Vault in Rhinoplasty: A New Classification of Spreader Flaps/Grafts

Abstract

After hump removal in reduction rhinoplasty, one of the main steps is to rebuild the middle vault. Spreader grafts have long been the main tool for the surgeon. Within the last two decades, the spreader flaps have started to be very popular as well. In accordance with the experience and technical preferences of the surgeon, there are many different options. In this article, the spreader grafts are classified as traditional, modified, splinting, and reconstructive. The spreader flaps are designed in accordance with their relationship with the septum and the spreader grafts.

Spreader Flap versus Spreader Graft in Dorsal Reconstruction following Hump Resection in Primary Closed Rhinoplasty

“…The first designed spreader was a cartilage graft placed on either side of the dorsal septal edge. These grafts can be placed in closed pockets [4] or placed in an open field and fixed using mattress sutures [3] .…”

“…Grafts can provide different designs and volumes to achieve the desired objective. In addition it can be introduced into tight pockets created on either side of the dorsal septum without fixation [3] . However, adequate material is needed to design such grafts.…”

“…Dorsal hump resection results in removal of a critical part of the Osseo-cartilaginous dorsum which necessitates mid-vault reconstruction [2] . The bony dorsum is simply reconstructed first by inward fracture of the nasal bones [3] , however, the cartilaginous dorsum must be reconstructed in a way to prevent bony cartilaginous disjunction otherwise an inverted-V deformity may occur. Reconstruction should maintain an open nasal valve to prevent mid-vault insufficiency and internal nasal valve (INV) collapse [2] .…”

Geometric Modeling of the Nasal Valve

“…Finally, the importance of lateral wall stiffness and support should be appreciated. Procedures to decrease inward collapse, such as ULC flaring sutures 8 or spreader flaps, 24 can play an important role in improving or preventing nasal obstruction postoperatively. Even if the ULCs are simply stabilized rather than flared, dynamic nasal obstruction is less likely.…”

Evaluation of the use of Different Spreader Techniques in Primary Open Septorinoplasty in Terms of Nasal and Olfactory Functions

“…4,5 Concerning the history of spreader grafts, despite dating back to earlier times, their popularity is still increasing today. 6,7 Although their contribution to esthetic satisfaction cannot be ignored, their role in functional outcomes (in terms of nasal obstruction and olfactory function) and the superiority of one method over another have not yet been clearly revealed.…”