The Safety and Efficacy of Spreader Grafts and Autospreaders in Rhinoplasty: A Systematic Review and Meta-analysis

Overview

The study systematically evaluated the evidence on outcomes and complications of spreader grafts and autospreader flaps when rebuilding the middle of the nose after hump removal. It followed the Cochrane Handbook for Systematic Reviews of Interventions, with inclusion criteria based on the population, intervention, comparison and outcome framework. Medline, EMBASE, Cinahl, Scopus and Web of Science were searched for studies published before March 2021.

Sections of note

• Systematic review and meta analysis; 52 of 1,129 relevant studies were included in the qualitative analysis; level of evidence III.
• Thirty four studies, 65.4 percent, concerned spreader grafts; 10 studies, 21.1 percent, autospreader flaps alone; and 8 studies, 13.5 percent, both.
• Meta analysis was performed on 17 studies reporting change in NOSE scores.
• The pooled effect was minus 23.9 points, 95 percent confidence interval minus 26.7 to minus 21.1.
• Heterogeneity was very high, I squared equals 99 percent.
• Summary data showed no difference between autospreader flap and no graft, P equals 0.7578.
• No difference was found between autospreader flap and spreader flap, P equals 0.9948.
• No difference was found between spreader graft and no graft, P equals 0.6608.

What it means for a patient

• Breathing scores improved substantially after rhinoplasty regardless of which technique, or whether any graft, was used.
• The heterogeneity figure of 99 percent means the included studies disagreed almost completely, which weakens the pooled estimate.
• The comparison groups were not randomized, so patients receiving no graft may have needed less support to begin with.
• The finding does not mean grafts are unnecessary, only that this pooled data cannot distinguish their effect.

Why this paper matters

Spreader grafts are standard practice after hump removal on the reasoning that the airway would otherwise narrow. This large review finds no measurable difference in patient reported breathing between using them, folding the cartilage instead, or doing neither. The extreme heterogeneity means the question is not settled.

Terms

• Spreader graft: a cartilage strip placed beside the septum to widen the internal breathing valve.
• Autospreader flap: the patient's own upper cartilages folded inward for the same purpose.
• Middle vault: the middle third of the nose between the bony bridge and the tip.
• NOSE score: the Nasal Obstruction Symptom Evaluation, where lower is better.
• Heterogeneity, I squared: a measure of how much the included studies disagree.