Spreader Graft Versus Spreader Flap in Rhinoplasty: A Systematic Review and Meta-Analysis of Aesthetic and Functional Outcomes

Background Insufficient support of the nasal mid-vault during rhinoplasty can cause significant complications. Accordingly, surgeons recently pay much more attention to the preservation of nasal patency. The spreader graft is the gold standard technique for the reconstruction of nasal mid-vault. Objectives The objective of this study was to compare the spreader graft and spreader flap in terms of aesthetic and functional outcomes. Methods An inclusive search was performed using PubMed/Medline, Google Scholar, Cochrane Library databases up to April 2021. Multiple aesthetic and functional factors including dorsal aesthetic lines restoration, satisfaction rate, internal nasal valve angle improvement, nasal obstruction symptom evaluation (NOSE) scale, and active anterior rhinomanometry (AAR) were evaluated. Also, a meta-analysis was performed on included articles that provided adequate data for mentioned factors. Results After excluding papers that did not conform with the selection criteria, 10 articles with a total sample size of 567 cases with a mean age of 27.7 (range: 18- 65) were finally included. Analysis of the data revealed no statistically significant difference between the spreader graft and spreader flap techniques in terms of dorsal aesthetic lines restoration, internal nasal valve angle improvement, NOSE scale, and AAR. Conclusions However, in terms of satisfaction rate, the analyzes indicated that spreader graft has significantly superior aesthetic outcomes. Generally, in case of appropriately selected patients, there is no statistically significant difference between spreader graft and spreader flap techniques in terms of aesthetic and functional outcomes.

Functional and aesthetic outcomes of spreader graft and auto-spreader flap after nasal hump removal

Background Following the reduction of the nasal hump to a desired level, spreader grafts are usually positioned to prevent the complication of nasal valve collapse. Auto-spreader flap is a new technique that gained more popularity recently and can be used as an alternative to spreader graft. This RCCT compared between both techniques aesthetically and functionally as well as the operative time. Results Forty patients, 17 males (42.5%) and 23 females (57.5%), were included. The mean duration of operation in auto-spreader flap was 11.8 ± 3.4 min, while it was 19.2 ± 3.2 min in spreader graft. The difference between the two procedures was statistically significant (P < 0.05). Functional assessment of nasal obstruction was done for all patients in both groups preoperative that was (75.6 ± 19.9) which showed marked improvement when re-evaluated 3 moths postoperatively (18.9 ± 14.7), and after 6 months NOSE scale was (29.1 ± 20.2). The overall aesthetic satisfaction was 62.5% (25 of 40) irrespective of the surgery done. Sixteen out of 20 patients in spreader group and 9 out of 20 in auto-spreader flap group. Conclusion Auto-spreader flap and spreader graft are very effective surgical procedure for treatment of nasal obstruction due to internal nasal valve dysfunction, but the auto-spreader flap had shorter operative time. However, spreader graft has a superior aesthetic outcome.

The Aesthetic and Functional Roles of Spreader Flap in Primary Rhinoplasty

Dorsal hump resection was considered as the most ordinary part of rhinoplasty. It is obviously noticed that when a humpectomy is performed in a primary rhinoplasty, some surgeons underestimate the middle third (internal valve) reconstruction resulting in an inverted-V deformity. Although spreader graft is the gold standard for middle vault reconstruction, attention is turned to returning a portion of the hump following dorsal reduction in an attempt to reconstruct the middle vault. The aim of this study is to evaluate the use of spreader flap in primary rhinoplasties. This study included 40 patients classified into 3 groups as follows: (1) type I—mild cartilaginous hump, (2) type II—moderate cartilaginous hump, and (3) type III—huge cartilaginous hump. The results are satisfactory in most cases regarding the aesthetic and functional outcomes. Using auto-spreader flaps is shown to be simple, reproducible, and effective in shaping the midvault while keeping the internal valve intact.