Is it a necessity to add spreader grafts to the nose when performing osteotomies? Why or why not?

Question

It seems like spreader grafts make the nose tip and nasal bones appear wider.

Ronald J. Edelson, MD · Answer

Spreader grafts have their place in rhinoplasty but they do not need to be used routinely. I have never used spreader grafts in primary rhinoplasty and have not seen the problems other surgeons say will occur. I think they are far too commonly used unnecessarily

Alejandro Nogueira, MD · Answer

Spreader grafts are, nowadays, a must in some cases of revision or secondary rhinoplasties; it is extremely odd to find a case of primary rhinoplasty in need of them.

Andrew Miller, MD · Answer

If spreader grafts are used properly, they don't necessarily make the nasal bones look wide - they help the support the nasal bones to maintain a natural line. If there is a bit of collapse of the bone of middle third of the nose, or if there is a slight curvature, spreader grafts can be very useful. However they are not needed just because an osteotomy was done. Be sure a to see a rhinoplasty specialist for consultation

Catherine Winslow, MD · Answer

Hello! Spreader grafts are placed below the nasal bones and typically above the tip so they make the area BETWEEN the bones and tip appear wider, although the effect can be slight depending on the width of the graft. They are used to prevent the sidewalls from caving in over time and causing nasal obstruction and cosmetic deformities, and are often used when large humps on the nose are reduced. They are not always needed when nasal bones are broken but every nose is different. Good luck!

Justin C. Cohen, MD, FACS · Answer

There are a number of reasons why spreader grafts might be needed during rhinoplasty. Simply having osteotomies doesn't necessarily mean they are required.Generally speaking spreader grafts are used to support the middle third of the nose and provide correction for a crooked nose or a narrow internal nasal valve (which can cause airway obstruction).Osteotomies are often done to help close an "open roof" leftover from reducing a large hump. In these cases spreader grafts are often very useful.  The grafts can be carved specifically to minimize the widening effect if needed. Obviously, the reason for using them is dependent on your individual anatomy and indication so be sure to discuss this with your surgeon. Good luck!

David W. Kim, MD · Answer

There are numerous reasons a surgeon may use spreader grafts during rhinoplasty.  The most common is to support the cartilages which form the middle part of the bridge after a hump is lowered.  They can also be used to improve nasal airflow constriction, straighten a crooked nose, or to repair collapse after trauma.  It is not necessarily the case that spreader grafts have to be used after osteotomies, although there may be other reasons they would be a good idea in any given surgery.  It really depends on the nose, the anatomical issues needing to be fixed, and the goals of the patient.  The video link shows an explanation of one use of spreader grafts for nasal valve problems.

Steven J. Pearlman, MD, FACS · Answer

There are a number of reasons for using spreader grafts. Each surgeon has their own guidelines. For me the basic reasons are: short nasal bones, narrow middle third of the nose (middle vault), crooked middle third of the nose, removal of a large hump and treatment of a tension nose. These are specific medical terms. Ask your surgeon why you may or may not be a candidate for spreader grafts. Personally, I use them more often than not.

Tanveer Janjua, MD · Answer

It is not necessary to use spreader grafts in every case of nasal osteotomies.  They should be used in cases where there is a concern of nasal valve narrowing or the middle third of the nose appears to be narrower than the upper one third and the lower one third.RegardsDr. J

William Portuese, MD · Answer

Spreader grafts are placed for a variety of reasons which include weak upper lateral cartilages that are concave on either one or both sides of the nose. There also placed for both cosmetic and functional reasons. For more information and many examples, please see the link and the video below

Steven Wallach, MD · Answer

Spreader grafts are used to improve the middle vault airway, and also to camouflage septal deviations.  Yes, they can make the middle vault look a bit wider.

Is it a necessity to add spreader grafts to the nose when performing osteotomies? Why or why not?

Answers (13)

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