Spreader Grafts in Functional Rhinoplasty

Overview

Problems in the middle vault, such as internal nasal valve collapse, an inverted-V deformity and an uneven bridge, are described as best prevented rather than corrected. The authors list features that can be spotted at consultation which mark a patient as at risk, then set out preventive measures, with spreader grafts as the mainstay of reconstruction.

Sections of note

• The article is a review chapter, not a study of patients.
• Risk factors identifiable before surgery: short nasal bones, long and weak upper lateral cartilages, thin skin, previous trauma or surgery, a positive Cottle manoeuvre, tension nose deformity, and inferior turbinates positioned far forward.
• Preventive measures named: preserving middle vault support, restrained removal when reducing a bridge hump, conservative bone cuts, and structural grafting.
• Spreader grafts are described as the workhorse of middle vault reconstruction.
• They restore the dorsal aesthetic lines, repair or maintain the internal nasal valve, and buttress a corrected crooked nose.
• Middle vault problems are stated to be among the most common reasons patients seek revision. No measured rates appear in the abstract.

What it means for a patient

• Certain features, including thin skin and short nasal bones, make middle vault problems more likely, and can be identified at consultation.
• The inverted-V deformity is a visible shadow across the middle of the nose caused by the roof collapsing after a hump is removed.
• Spreader grafts are placed to hold the airway open and keep the bridge lines straight, so they serve appearance and breathing at once.
• A narrative review with no reported rates cannot say how often prevention succeeds or how much grafts reduce revision.

Why this paper matters

The middle vault is where reduction rhinoplasty most often causes trouble later, because removing a hump opens the roof of the nose. Cataloguing risk factors before surgery is the preventive framework. Whether routine spreader grafting lowers revision rates has not been settled by comparative data.

Terms

• Middle vault: the middle third of the nose, between the nasal bones and the tip.
• Spreader graft: a narrow cartilage strip placed alongside the septum to widen and support the airway.
• Internal nasal valve: the narrowest part of the nasal airway.
• Inverted-V deformity: a visible V-shaped shadow where the nasal bones meet collapsed cartilage.
• Cottle manoeuvre: a test pulling the cheek outward to see whether breathing improves.