Do spreader grafts compromise your breathing?

Question

I recently had my second revision , with Dr. Torgerson four months ago- where he use spreader grafts to "open" the nasal passages of my nose. Although cosmetically pleasing on the outside, I can't feel the air going into the nose properly? feels like hollowness not temperature regulated.. I am 4 months post op, can this OCCUR where the donor tissue will cause the breathing senses to compromise? Does the lining eventually heal? CAn someone offer feedback? 4 months seems to be a long time

Garrett Griffin, MD · Answer

Hi Veronica: There is actually some debate about how well spreader grafts work for breathing improvement.  They typically do straighten the dorsum and help surgeons control the transition of the upper nose to the tip, so they do offer the possibility of a cosmetic improvement.  They were initially described to improve breathing, but they do take up space and so in some people probably offer little to no improvement in breathing. Some studies in cadavers actually suggest they may narrow the breathing passage.  Another possibility is that your nose is so open that you can't feel air moving, even if you are actually breathing fine.  If this is the case, try to be patient for the nerves to come back. In the meantime, help moisturize the inside of your nose with saline gels and sprays.  Best of luck.

Steven Wallach, MD · Answer

Spreader grafts are thought to keep the middle vault open and improve breathing when this angle is closed down. It may be swelling that is contributing to your sensation.

Danny Soares, MD · Answer

Spreader grafts can have an impact upon both on the appearance and the function of the nose. Typically, from a functional standpoint, spreader grafts are often helpful in improving nasal function and breahting because they tend to "spread" open the width of the nasal passage, which helps prevent complete valvular collapse. Despite that, the act of placing spreader grafts can result in more swelling around the internal valve area and lead to temporary nasal obstruction. As mentioned by Dr. Frodel, typically, nasal obstruction over the short term following rhinoplasty is more often secondary to some remaining swelling intranasally. Ideally, your surgeon will evaluate your nose inside and out to assess the cause of the obstruction. It is not uncommon for patients with nasal allergies to have worsening of allergic symptoms after rhinoplasty if air flow is improved, resulting in more swelling and a sensation of obstruction. In such cases, an nasal anti-inflammatory spray would be helpful. Best of luck to you!

John Frodel, MD · Answer

At 4 months after surgery, especially in revision rhinoplasty, there is likely residual swelling in the area where the grafts were placed.  Hopefully when this swelling resolves over the next few months you will note the breathing improvement that you were hoping for.

R. Stephen Mulholland, MD (retired) · Answer

Dear Veronica mx,

Revision rhinoplasty externally performed and internally
performed is generally accompanied by prolonged swelling and edema.  The indications for use of a spreader graft
would generally be for aesthetic contouring of the middle vault or middle third
of the nose and if there were compromised airflow through the internal valve.

Dr. Torgerson is an excellent rhinoplasty surgeon, so I am
sure you’re in very good hands. The use of the spreader graft for either
cosmetic or functional purposes would likely not lead to long-term functional
compromise in his hands. There is definitely going to be prolonged swelling in
secondary rhinoplasty and four months is a little early to make a final
analysis of the postoperative airflow down either air passage.  In the short and long term, there are some
things that can be performed to improve airflow following spreader graft and
rhinoplasty.  This can include simple
injection of hyaluronic acid gel in the internal valve to assess whether
additional splinting of a compromised angle will improve airflow, but at this
early phase that might be premature and simply returning to see Dr. Torgerson
for his reassurance is probably in your best interests at this point.  Over the next six to ten months, any
long-term compromised airflow will reveal itself and Dr. Torgerson is in the
best position to advise you as to the next steps.

I do believe over time things will improve.  If not, there are steps and measures to
improve airflow, even in a tertiary rhinoplasty scenario.

I have been performing cosmetic and functional rhinoplasty
for almost 29 years, having studied both plastic surgery and ear/nose/throat,
head and neck oncology.  I can tell you
that seeking the expertise of a consultant surgeon with expertise in the
plastic as well as the functional ENT component, as you have done, is probably
your most important decision.  Be
patient, stick with Dr. Torgerson and best of luck.

For more information, please review the link below.

Sincerely,

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Do spreader grafts compromise your breathing?

Answers (5)

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