Role of Spreader Flaps in Rhinoplasty: Analysis of Patients Undergoing Correction for Severe Septal Deviation with Long-Term Follow-Up

Overview

Severe septal deviation is difficult to correct durably, and surgeons disagree about whether flaps, grafts, both or neither should be used. This randomized study compared all four options, measuring the deviation angle on images and collecting satisfaction on a validated questionnaire.

Sections of note

• 264 patients who had primary rhinoplasty between January 2010 and September 2016 met inclusion criteria.
• Randomized into four groups: group 1 spreader flaps plus spreader grafts; group 2 flaps alone; group 3 grafts alone; group 4 neither.
• Patients answered the Italian version of the FACE-Q rhinoplasty module.
• Anthropometric measurements were made with AutoCAD, determining the angle of deviation before and after surgery, compared with the chi-squared test.
• Two plastic surgeons reviewed all postoperative photographs and rated them on a scale of 1 to 5.
• Group 1 showed statistically significant differences from the other groups in deviation angle change, P below 0.01, and maintained an angle close to 180 degrees over long-term follow-up.
• Groups 1 and 3 were more satisfied than groups 2 and 4, P below 0.01, and were also rated most satisfactory by the two reviewers. Level of evidence IV.

What it means for a patient

• Using both a flap and a graft together gave the straightest and most durable result for a severely deviated septum.
• Flaps alone performed no better than doing neither on satisfaction.
• Grafts alone gave satisfaction comparable to the combination, but not the same durability of correction.
• Limits: single center, the abstract gives no follow-up duration despite the long-term claim, and the level of evidence is stated as IV despite the randomized design.

Why this paper matters

Middle vault reconstruction after correcting a deviated septum is done differently by different surgeons with little comparative evidence. A four-arm randomized comparison in 264 patients is unusually strong for this field. The unstated follow-up length limits how the durability claim can be read.

Terms

• Septal deviation: A crooked central wall inside the nose.
• Spreader graft: A separate cartilage strip placed alongside the septum for support.
• Spreader flap: The upper lateral cartilage folded inward and used instead of a graft.
• Angle of deviation: The measured departure of the nose from straight; 180 degrees is straight.
• FACE-Q: A modular validated questionnaire covering facial appearance outcomes.