I had a previous rhinoplasty where a dorsal hump was removed leaving me with a collapsed internal nasal valve. The doctor said he would use a closed approach to fix my problems. He said he does not used spreader grafts, rather he uses another type of graft to support the sidewall of the nose. It seems that all of the articles I read say that this type of problem calls for a spreader graft. Is it unusual not to use one? Also would this graft would improve the crookedness of my nose as well?
Is a Spreader Graft Necessary to Fix Nasal Valve Collapse?
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Doctor Answers 33
Nasal Valve Collapse, Spreader versus Onlay Graft
The question you ask is simultaneously both simple and complicated. The essential truth is that both grafts will help with correction of a crooked nose and both will help with functional problems. However, there are subtle differences between the 2 options.
Difference #1: Approach
I do spreader grafts through a closed approach typically, but many surgeons will only place them using an open approach. If an open approach seems like too much surgery for a single graft, then many surgeons will use an onlay graft instead, which can always be done closed and is technically much simpler.
Difference # 2: Airway affect
If your nasal sidwall collapses when you inspire, then too much cartilage was removed at the first surgery and you probably need an onlay graft more than a spreader graft. A spreader graft will lift and support the cartilage but not strengthen it. An onlay graft will add strength to the underlying cartilage that is weak by helping to stiffen the sidewall. Conversely, if your valve is narrow but not collapsing, a spreader graft is a better choice becuase it actually lateralizes the canopy cartilage, opening up the airway. In more extreme deviations with collapse, I will often use both a spreader and an onlay.
Difference # 3: Cosmetic effect
A spreader graft will give more subtle deviation correction and it tends to add width only paradorsally (that is closer to the center of the profile). I personally like this cosmetic effect more than the effect you see with onlay grafts. Onlay grafts add width in the entire nasal sidewall, which results in a slightly wider looking nose with less shadow contrast. However, for more extreme nasal deviations, onlay grafts give bigger corrections and are a little more predictable. Again, sometimes I will use both in a single patient.
Besides these differences, there are other technical ones that are less important, such as donor cartilage availability and swelling after surgery. All in all, neither is a bad choice. If you are using a reputable surgeon with a good track record of success, then follow their suggestion, as it is probably based on their impression from your examination.
Best of luck
Spreader Graft Often Used for Internal Nasal Valve Collapse
A collapsed internal nasal valve is often repaired with a spreader graft. I personally place these with and external approach but it can be done closed as well. A batten graft may be used as well. These are usuallly used to repair an external valve collapse. The terminology can be confusing and the surgery is quite specialized. If your surgeon is experienced trust their recommendation.
Spreader grafts for nasal valve narrowing.
There are many ways to improve breathing when the cause is pinching or narrowing of the side walls of the nose. Spreader grafts are thin slivers of cartilage placed or sutured between the edge of the septum just below the skin and the flat cartilaginous plate supporting the side wall of the nose. Although spreader grafts are popular, they are not the only way. It is far easier to place them using an open approach. This is complicated surgery and you should get a second opinion.
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Spreader Grafts should be used in nearly all cases of dorsal hump reduction
Spreader grafts are frequently used in rhinoplasty. Spreader grafts are strips cartilage made of patients own cartilage that are placed on each side of the septum ( between the septum and the side wall). Typically, the mid or lower portion of the septum is harvested to make spreader grafts. I prefers to use patient’s own septal cartilage to make the spreader grafts in primary rhinoplasty. I place them using closed rhinoplasty techniques.
1. Why are spreader grafts needed?
Spreader grafts are very important to prevent midnasal collapse (also known as an internal nasal valve collapse or inverted V deformity).
The dorsal aspect of the septum (the top or the bridge) is naturally wider than the portion below it, looking like a letter T. The wider part of the T holds the side walls apart. This is the internal nasal valve. When the dorsal hump is removed that wide portion of the septum (horizontal part of the T) is removed in most cases leaving the narrow portion of the septum, looking like an letter I. Without reconstructing that wide portion of the dorsal septum, the side walls will invariably collapse causing nasal valve obstruction (breathing obstruction) and cosmetically collapsed nose, called an inverted V deformity. Therefore, in nearly all cases, when dorsal hump reduction is performed, spreader grafts should be used to prevent the sidewalls from collapsing. In some patients, with or without the dorsal hump, the wider portion of the T is naturally narrow causing nasal valve collapse on inspiration. Spreader grafts are used to reconstruct the internal nasal valve and improve nasal airway patency in these patients.
Furthermore, the spreader grafts also used close the open roof following dorsal hump reduction.
So, spreader grafts support the sidewalls, preventing them from collapsing and maintaining or improving the internal nasal valve. Aesthetically, spreader grafts allow to produce smoother nasal contour line from the forehead to the tip on the front view, knows as dorsal aesthetic lines. The spreader are placed between the septum and the lateral walls.
Please research Inverted V deformity to see what an Inverted V deformity looks like when spreader grafts are not used.
2. Will spreader grafts make the nose wider following dorsal hump reduction?
Patients with a wide dorsum (bridge) will have narrower noses following dorsal hump reduction, spreader graft placement and nasal bone narrowing via osteotomies.
Those patients with a narrow midportion of the bridge preoperatively will have a slightly wider midportion of the nose after spreader graft placement, which would be aesthetically more appropriate and better functionally.
Patients with an average dorsal width of about 7 -12mm will usually have about the same width after surgery as before surgery. It is possible for the width of the midnasal area to be slightly wider after surgery if the nose is significantly deviated and additional spreader grafts are needed to keep the nose straight.
It is very important to note that even 12 months after rhinoplasty there is still a small amount of swelling that takes years to go away. So, the nose may initially appear wider and continue to narrow during the first several years.
It is not unusual to use spreader grafts for patients who have nasal valve collapse. These cartilage grafts can also be used to straighten the nose. It is difficult to correct this problem through a closed approach, and you may want to seek a second opinion.
A Deviated Septum is not the only cause of Nasal Airway Obstruction.
It appears that you may have had some collapse of your internal nasal valve after the initial surgery. However, nasal airway obstruction may be due to a number of causes. A deviated septum, enlarged turbinates, or valve collapse are all culprits of poor nasal breathing. It is important to obtain a thorough exam by a rhinoplasty specialist to determine the cause of your poor nasal function.
Spreader grafts can help internal nasal valve collapse. However, there are a number of other grafts that can also improve the internal valve such as splay grafts, butterfly grafts, etc. The type of graft used will depend on the remaining cartilage (septum, ear, etc) that may be available, the comfort level of that surgeon with that technique, and the severity of the valve collapse. The external nasal valve should also be thoroughly evaluated to assure this does not also need to be addressed.
Rhinoplasty for Nasal Obstruction
The answer to both of your questions depends upon what is in fact causing the nasal obstruction. There are several different causes to this and can include a deviated septum, turbinate enlargement, or valve collapse. Valve collapse can further be classified into the external valve and the internal valve. A spreader graft will not help in all types of valve collapse, so you must have a thorough nasal examination by a nose specialist in order to determine this.
Regarding you second question about wether or not a spreader graft will correct a deviation in your nose; this too will depend. There are several causes for deviation of the nose, and it usually is a combination of different factors. A spreader graft will NOT always correct deviation. Again, a thorough physical examination by a rhinoplasty/nose specialist will help discern the answer.
Spreader grafts, rhinoplasty
Spreader grafts are great. They help people breathe by opening the internal nasal valve. Interestingly enough, the concept for breathe-rigth nasal strips is based on this idea. They also help support the middle portion of the nose, quite well I might add. All plastic surgeons that I know and have been trained by use them routinely.
Spreader grafts are commonly used to correct nasal valve collapse and indeed may also be useful for correction of a crooked nose especially where extensive septal work needs to be done.