Abstract
The aesthetic uses of spreader grafts include straightening or strengthening a dorsally deviated septum, preventing or correcting a narrow midvault, and establishing uniform and symmetric dorsal aesthetic lines, and in some cases widening a narrow middle vault. It is this tendency to overly-widen the dorsum which surgeons find objectionable and the reason why many opt not to employ spreader grafts. However, spreader grafts can be recessed slightly below the height of the dorsum to alleviate undesired widening of the nose while still maintaining their usefulness.
22 Ancillary Maneuvers in Rhinoplasty: Spreader Grafts
Key Points
The aesthetic uses of spreader grafts (Fig. 22.1) include straightening or strengthening a dorsally deviated septum, preventing or correcting narrowing of the midvault, and establishing uniform and symmetric dorsal aesthetic lines, and in some cases widening a narrow middle vault.
Spreader grafts should be placed bilaterally.
Recess the spreader grafts 1 to 2 mm to prevent undesired widening of the dorsum (Fig. 22.2).
The upper lateral cartilages are trimmed to the appropriate height and sutured to the spreader graft–septum complex with simple sutures to recreate an anatomic configuration of the midvault.
22.1 Preoperative Steps
Proper preoperative analysis should be performed and surgical goals established.
Particular attention should be paid to the dorsal width and the need to maintain dorsal width versus narrowing or widening the midvault.
22.2 Operative Steps
An open approach is favored to allow adequate visualization of the osseocartilaginous framework.
Divide the upper lateral cartilages from the dorsal septum and perform a component dorsal reduction if necessary, while leaving the upper lateral cartilages untrimmed until subsequent operative steps (see below).
Harvest septal cartilage for grafting.
Fabricate two spreader grafts measuring approximately 4 mm in height. The length should be sufficient to span the entire length of the midvault from the keystone to the septal angle.
Place the spreader grafts on either side of the septum and secure in two to three locations with horizontal mattress sutures. If no widening of the dorsum is desired, the spreader grafts should be recessed 1 to 2 mm below the height of the dorsal septum (Fig. 22.3).
The upper lateral cartilages are trimmed to the height of the dorsal septum and sutured to the spreader graft–septum complex with simple sutures tied across the top of the dorsum so that the upper lateral cartilages meet the side of the dorsal septum and cover the top of the spreader grafts (Fig. 22.4).
If lateral osteotomies are to be performed, these should be done after the midvault has been reconstituted.
See Video 22.1.
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