eMedicine Specialties > Plastic Surgery > Nose

Rhinoplasty, Spreader Grafts: Multimedia

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

Multimedia

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Media file 1: This young female rhinoplasty patient presented with a crooked nose deformity. This was a result of congenital deviation of her dorsal septum to her left side. As noted diagrammatically, her bony nasal vault was quite straight (vertical blue line). Her dorsal septum, however, was deviating toward the left side (angled red line), contributing to a crooked alignment.

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This young female rhinoplasty patient presented with a crooked nose deformity. This was a result of congenital deviation of her dorsal septum to her left side. As noted diagrammatically, her bony nasal vault was quite straight (vertical blue line). Her dorsal septum, however, was deviating toward the left side (angled red line), contributing to a crooked alignment.

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Media file 2: Brow-tip aesthetic line with significant contribution made by the middle vault region.

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Brow-tip aesthetic line with significant contribution made by the middle vault region.

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Media file 3: Diagram of composite spreader graft placement in between the upper lateral cartilage and dorsal septum. As noted, the composite graft includes cartilage and skin intended to replace the cartilage and mucosal lining that is deficient in the internal nasal valve segment.

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Diagram of composite spreader graft placement in between the upper lateral cartilage and dorsal septum. As noted, the composite graft includes cartilage and skin intended to replace the cartilage and mucosal lining that is deficient in the internal nasal valve segment.

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Media file 4: Diagram of spreader graft variation used to correct a pinched nasal tip. The graft is shaped as either a rectangle or triangle and placed in between the lower lateral cartilages to widen the tip contour and shape.

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Diagram of spreader graft variation used to correct a pinched nasal tip. The graft is shaped as either a rectangle or triangle and placed in between the lower lateral cartilages to widen the tip contour and shape.

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Media file 5: Example of explanted septal cartilage to be used for grafting purposes. Notice ample amount of cartilage material that can be harvested during a primary case. Cartilage is usually sufficient to fashion 2 equivalent-sized spreader grafts (see black arrow) as well as tip and batten grafts, if necessary.

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Example of explanted septal cartilage to be used for grafting purposes. Notice ample amount of cartilage material that can be harvested during a primary case. Cartilage is usually sufficient to fashion 2 equivalent-sized spreader grafts (see black arrow) as well as tip and batten grafts, if necessary.

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Media file 6: Example of surgical exposure of middle vault region in preparation for spreader graft placement. Notice separation of the medial edge of the upper lateral cartilage from the dorsal septum margin. Also note how crooked the dorsal septum is in this patient. The primary indication for placement of the spreader grafts in this patient was to achieve more bridge symmetry.

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Example of surgical exposure of middle vault region in preparation for spreader graft placement. Notice separation of the medial edge of the upper lateral cartilage from the dorsal septum margin. Also note how crooked the dorsal septum is in this patient. The primary indication for placement of the spreader grafts in this patient was to achieve more bridge symmetry.

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Media file 7: Diagram of spreader graft placement with use of horizontal mattress sutures for secure positioning.

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Diagram of spreader graft placement with use of horizontal mattress sutures for secure positioning.

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Media file 8: This is an example of spreader graft placement for a crooked nose deformity. This patient had a high dorsal deflection (crooked dorsal septum) that was causing the lower aspect of her nose to deviate to her left side. A spreader graft was placed to splint the dorsal septum into a straighter position, thus creating more symmetry, as seen on her postoperative frontal view.

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This is an example of spreader graft placement for a crooked nose deformity. This patient had a high dorsal deflection (crooked dorsal septum) that was causing the lower aspect of her nose to deviate to her left side. A spreader graft was placed to splint the dorsal septum into a straighter position, thus creating more symmetry, as seen on her postoperative frontal view.

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Media file 9: This intraoperative photo demonstrates proper placement of the spreader graft in cases of a high septal deflection. The blue arrows correspond to the medial margin of the upper lateral cartilage, which has been separated from the dorsal septum. The yellow arrow corresponds to the spreader graft placed on the left side (green arrow), helping to splint the concave side of the deviated septum.

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This intraoperative photo demonstrates proper placement of the spreader graft in cases of a high septal deflection. The blue arrows correspond to the medial margin of the upper lateral cartilage, which has been separated from the dorsal septum. The yellow arrow corresponds to the spreader graft placed on the left side (green arrow), helping to splint the concave side of the deviated septum.

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Follow-up: Rhinoplasty, Spreader Grafts

Multimedia: Rhinoplasty, Spreader Grafts

References

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References

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Guyuron B, Michelow BJ, Englebardt C. Upper lateral splay graft. Plast Reconstr Surg. Nov 1998;102(6):2169-77. [Medline].
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Heinberg CE, Kern EB. The Cottle sign: an aid in the physical diagnosis of nasal airflow disturbances. Rhinology. 1973;11:89-94.
Goode RL. Surgery of the incompetent nasal valve. Laryngoscope. May 1985;95(5):546-55. [Medline].
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Beekhuis GJ. Nasal obstruction after rhinoplasty: etiology, and techniques for correction. Laryngoscope. Apr 1976;86(4):540-8. [Medline].
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Naito K, Cole P, Chaban R. Nasal resistance, sensation of obstruction, and rhinoscopic findings compared. Am J Rhinol. 1988;2:65-69.
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.
Rohrich RJ, Hollier LH. Use of spreader grafts in the external approach to rhinoplasty. Clin Plast Surg. Apr 1996;23(2):255-62. [Medline].
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].
Tebbetts JB. Alar spreader or lateral crural spanning graft? Some additional observations. Plast Reconstr Surg. Aug 1993;92(2):366-8. [Medline].
Toriumi DM. Management of the middle nasal vault in rhinoplasty. In: Operative Techniques in Plastic Reconstructive Surgery. Vol 2. 1995:16.
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.
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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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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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eMedicine Specialties > Plastic Surgery > Nose

Rhinoplasty, Spreader Grafts: Multimedia

Multimedia

Brow-tip aesthetic line with significant contribution made by the middle vault region.

Diagram of composite spreader graft placement in between the upper lateral cartilage and dorsal septum. As noted, the composite graft includes cartilage and skin intended to replace the cartilage and mucosal lining that is deficient in the internal nasal valve segment.

Diagram of spreader graft variation used to correct a pinched nasal tip. The graft is shaped as either a rectangle or triangle and placed in between the lower lateral cartilages to widen the tip contour and shape.

Diagram of spreader graft placement with use of horizontal mattress sutures for secure positioning.

More on Rhinoplasty, Spreader Grafts

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor