eMedicine Specialties > Plastic Surgery > Nose

Rhinoplasty, Spreader Grafts: Workup

Author: John M Hilinski, MD, Clinical Instructor in Surgery, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego Medical Center; Private Practice, San Diego Face and Neck Specialties PC
Coauthor(s): Patrick Byrne, MD, Associate Professor, Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine; Deborah Watson, MD, Associate Professor, Department of Surgery, Division of Head and Neck Surgery, University of California at San Diego School of Medicine
Contributor Information and Disclosures

Updated: May 26, 2009

Workup

Diagnostic Procedures

  • Numerous studies have reported the utility of rhinomanometric analysis in various models of nasal obstruction, including internal valve abnormalities.7,8,9 Rhinomanometry helps to evaluate resistance to airflow but does not provide accurate information about the location of the obstruction. Little data are available investigating rhinomanometric analysis with isolated internal nasal valve dysfunction.
  • Acoustic rhinometry is a newer technique that is helpful in evaluating the cross-sectional area of the nose and localizing the site of obstruction.
  • Despite their purported use, much debate still exists regarding the relative inconsistencies between subjective complaints of obstruction and objective measurements and readings.9 Adequate assessment of internal nasal valve dysfunction and indications for spreader graft placement most often can be made on clinical grounds and physical examination alone.

More on Rhinoplasty, Spreader Grafts

Overview: Rhinoplasty, Spreader Grafts
Workup: Rhinoplasty, Spreader Grafts
Treatment: Rhinoplasty, Spreader Grafts
Follow-up: Rhinoplasty, Spreader Grafts
Multimedia: Rhinoplasty, Spreader Grafts
References
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References

  1. Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg. Feb 1984;73(2):230-9. [Medline].

  2. Guyuron B, Michelow BJ, Englebardt C. Upper lateral splay graft. Plast Reconstr Surg. Nov 1998;102(6):2169-77. [Medline].

  3. Santiago-Diez de Bonilla J, McCaffrey TV, Kern EB, Kern EB. The nasal valve: a rhinomanometric evaluation of maximum nasal inspiratory flow and pressure curves. Ann Otol Rhinol Laryngol. May-Jun 1986;95(3 Pt 1):229-32. [Medline].

  4. Heinberg CE, Kern EB. The Cottle sign: an aid in the physical diagnosis of nasal airflow disturbances. Rhinology. 1973;11:89-94.

  5. Goode RL. Surgery of the incompetent nasal valve. Laryngoscope. May 1985;95(5):546-55. [Medline].

  6. Gunter JP, Rohrich RJ. Correction of the pinched nasal tip with alar spreader grafts. Plast Reconstr Surg. Nov 1992;90(5):821-9. [Medline].

  7. Cole P, Chaban R, Naito K, Oprysk D. The obstructive nasal septum. Effect of simulated deviations on nasal airflow resistance. Arch Otolaryngol Head Neck Surg. Apr 1988;114(4):410-2. [Medline].

  8. Constantian MB, Clardy RB. The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast Reconstr Surg. Jul 1996;98(1):38-54; discussion 55-8. [Medline].

  9. Courtiss EH, Goldwyn RM. The effects of nasal surgery on airflow. Plast Reconstr Surg. Jul 1983;72(1):9-21. [Medline].

  10. Stal S, Hollier L. The use of resorbable spacers for nasal spreader grafts. Plast Reconstr Surg. Sep 2000;106(4):922-8; discussion 929-31. [Medline].

  11. Mendelsohn M. Straightening the crooked middle third of the nose: using porous polyethylene extended spreader grafts. Arch Facial Plast Surg. Mar-Apr 2005;7(2):74-80. [Medline].

  12. Beekhuis GJ. Nasal obstruction after rhinoplasty: etiology, and techniques for correction. Laryngoscope. Apr 1976;86(4):540-8. [Medline].

  13. Bridger GP. Physiology of the nasal valve. Arch Otolaryngol. Dec 1970;92(6):543-53. [Medline].

  14. Byrd HS, Salomon J, Flood J. Correction of the crooked nose. Plast Reconstr Surg. Nov 1998;102(6):2148-57. [Medline].

  15. McCaffrey TV. Nasal function and evaluation. In: Bailey B. Head and Neck Surgery- Otolaryngology. Vol 1. Philadelphia, Pa: JB Lippincott; 1993:262-8.

  16. Naito K, Cole P, Chaban R. Nasal resistance, sensation of obstruction, and rhinoscopic findings compared. Am J Rhinol. 1988;2:65-69.

  17. Rees TD. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty- discussion. Plast Reconstr Surg. 1984;73(2):238-239.

  18. Rohrich RJ, Hollier LH. Use of spreader grafts in the external approach to rhinoplasty. Clin Plast Surg. Apr 1996;23(2):255-62. [Medline].

  19. Stucker FJ, Hoasjoe DK. Nasal reconstruction with conchal cartilage. Correcting valve and lateral nasal collapse. Arch Otolaryngol Head Neck Surg. Jun 1994;120(6):653-8. [Medline].

  20. Tebbetts JB. Alar spreader or lateral crural spanning graft? Some additional observations. Plast Reconstr Surg. Aug 1993;92(2):366-8. [Medline].

  21. Toriumi DM. Management of the middle nasal vault in rhinoplasty. In: Operative Techniques in Plastic Reconstructive Surgery. Vol 2. 1995:16.

  22. Toriumi DM. The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty- discussion. Plastic Reconstructive Surgery. 1996;98:55-58.

  23. Toriumi DM, Ries WR. Innovative surgical management of the crooked nose deformity. Facial Plast Surg Clin. 1993;1:63.

  24. Zijlker TD, Quaedvlieg PC. Lateral augmentation of the middle third of the nose with autologous cartilage in nasal valve insufficiency. Rhinology. Mar 1994;32(1):34-41. [Medline].

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Further Reading

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Keywords

rhinoplasty, septorhinoplasty, spreader grafts, nasal grafts, alar spreader grafts, internal nasal valve, nasal valve stenosis, inverted V deformity, revision rhinoplasty, secondary rhinoplasty

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Contributor Information and Disclosures

Author

John M Hilinski, MD, Clinical Instructor in Surgery, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego Medical Center; Private Practice, San Diego Face and Neck Specialties PC
John M Hilinski, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, California Medical Association, and California Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Patrick Byrne, MD, Associate Professor, Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
Patrick Byrne, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, and American College of Surgeons
Disclosure: Nothing to disclose.

Deborah Watson, MD, Associate Professor, Department of Surgery, Division of Head and Neck Surgery, University of California at San Diego School of Medicine
Deborah Watson, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Frederick J Menick, MD, Clinical Associate Professor, Department of Surgery, Division of Plastic Surgery, University of Arizona College of Medicine; Facial and Nasal Reconstructive Surgeon, Tucson, Arizona
Frederick J Menick, MD is a member of the following medical societies: American Association of Plastic Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic and Reconstructive Surgery, American Society of Plastic Surgeons, and Canadian Society of Plastic Surgeons
Disclosure: none None None

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

George Peck, Jr, MD, Consulting Staff, Department of Plastic Surgery, St Barnabas Hospital of New Jersey
George Peck, Jr, MD is a member of the following medical societies: American Society for Aesthetic Plastic Surgery
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

John R Taylor, MD, FRCSC, FACS, Independent Practice, Ontario
John R Taylor, MD, FRCSC, FACS is a member of the following medical societies: American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, Canadian Medical Association, and Canadian Society of Plastic Surgeons
Disclosure: Nothing to disclose.

 
 
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