Assessment of Functional Rhinoplasty with Spreader Grafting Using Acoustic Rhinomanometry and Validated Outcome Measurements

Paul MA, Kamali P, Chen AD, Ibrahim AMS, Wu W, Becherer BE, Medin C, Lin SJ.

PubMed 29707440 Publisher (DOI)Free full text (PMC)

What this paper says

In 38 patients with internal nasal valve insufficiency treated with spreader grafts, the average minimal cross-sectional area of the nose increased significantly and all patients reported functional improvement on the NOSE scale.

Overview

Spreader grafts are used to hold open the narrowest part of the nasal airway, but few studies have measured both objective airway change and validated patient-reported outcomes. This retrospective review examined consecutive rhinoplasty patients treated by open and closed approaches over an 8-year period.

Sections of note

Retrospective review of consecutive rhinoplasty patients with internal nasal valve insufficiency, operated between 2007 and 2016.
178 patients were reviewed over the 8 years; 38 met inclusion criteria.
Of the 38, 30 underwent closed rhinoplasty and 8 open rhinoplasty.
Mean age 36.9 years, SD 18.4.
Obstruction was assessed with the Cottle test and the Nasal Obstruction Symptom Evaluation survey; patient-reported symptoms were recorded.
Acoustic rhinometry was performed before and after surgery, measuring average minimal cross-sectional area.
Average cross-sectional area increased significantly in both closed and open patients, P 0.019, and functional improvement was reported in all presented cases.

What it means for a patient

The narrowest point of the airway measurably widened, alongside patients reporting easier breathing.
The closed approach, without an external incision, achieved this in the large majority of these cases, 30 of 38.
Limits: 38 patients from 178 reviewed, retrospective, no comparison group without spreader grafts, very unequal open and closed groups, and no stated follow-up interval.
The abstract reports no NOSE score values, only that improvement occurred.

Why this paper matters

Spreader grafting for nasal valve collapse is widely done but rarely validated with both objective and patient-reported measures together. Showing it works through a closed approach matters because that avoids the external scar. The small sample and absence of a control group limit the strength of the conclusion.

Terms

Internal nasal valve: The narrowest part of the nasal airway, between the septum and the upper lateral cartilage.
Spreader graft: A cartilage strip placed alongside the septum to widen and support that area.
Acoustic rhinometry: A test using sound reflection to measure the cross-sectional area inside the nose.
Minimal cross-sectional area: The narrowest measured area of the nasal passage.
Cottle test: A bedside test where pulling the cheek outward reveals whether valve collapse causes the blockage.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Background: Rhinoplasty is 1 of the most common aesthetic and reconstructive plastic surgical procedures performed within the United States. Yet, data on functional reconstructive open and closed rhinoplasty procedures with or without spreader graft placement are not definitive as only a few studies have examined both validated measurable objective and subjective outcomes of spreader grafting during rhinoplasty. The aim of this study was to utilize previously validated measures to assess objective, functional outcomes in patients who underwent open and closed rhinoplasty with spreader grafting.

Methods: We performed a retrospective review of consecutive rhinoplasty patients. Patients with internal nasal valve insufficiency who underwent an open and closed approach rhinoplasty between 2007 and 2016 were studied. The Cottle test and Nasal Obstruction Symptom Evaluation survey was used to assess nasal obstruction. Patient-reported symptoms were recorded. Acoustic rhinometry was performed pre- and postoperatively. Average minimal cross-sectional area of the nose was measured.

Results: One hundred seventy-eight patients were reviewed over a period of 8 years. Thirty-eight patients were included in this study. Of those, 30 patients underwent closed rhinoplasty and 8 open rhinoplasty. Mean age was 36.9 ± 18.4 years. The average cross-sectional area in closed and open rhinoplasty patients increased significantly (P = 0.019). There was a functional improvement in all presented cases using the Nasal Obstruction Symptom Evaluation scale evaluation.

Conclusions: Closed rhinoplasty with spreader grafting may play a significant role in the treatment of nasal valve collapse. A closed approach rhinoplasty including spreader grafting is a viable option in select cases with objective and validated functional improvement.

Abstract as indexed by PubMed; the article is open access (PubMed Central).