The Use of Endonasal Spreader Grafts in Preservation Rhinoplasty

Go BC, Frost AS, Friedman O.

What this paper says

Three case examples show that spreader grafts can be placed through the closed approach during dorsal preservation rhinoplasty, with all three patients reporting better breathing.

Overview

Spreader grafts widen the internal nasal valve and are usually associated with structural, open surgery. Preservation rhinoplasty lowers the dorsum without disrupting the keystone area. Friedman's group describes combining the two, placing spreader grafts endonasally within a preservation operation, and presents three cases.

Sections of note

Extensive resection can cause valve incompetence and obstructive symptoms.
Endonasal spreader grafts widen the internal valve cross-section with limited incisions and preserved local structures.
Preservation rhinoplasty lowers the dorsum without major disruption of the keystone.
All three patients reported improved nasal obstruction symptoms after surgery.
The authors say the combination manages valve and dorsum "similarly to the external approach" without deconstruction.

What it means for a patient

Choosing preservation surgery does not rule out valve support if breathing is a concern.
Three cases is a demonstration of feasibility, not evidence of outcomes.
It is a closed technique, so no external scar.

Why this paper matters

It bridges functional valve surgery and dorsal preservation, two approaches often described as separate. Limits: three patients, no measurements, no follow-up stated.

Terms

Spreader graft: a cartilage strip placed between the septum and upper lateral cartilage.
Internal nasal valve: the narrowest part of the nasal airway.
Keystone area: where the nasal bones, upper lateral cartilages and septum meet mid-bridge.
Endonasal: performed through incisions inside the nose.
Valve incompetence: collapse or narrowing of the valve that blocks airflow.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Rhinoplasty is a complicated procedure that requires surgical finesse and precision to sculpt a framework that suits each patient's unique anatomical needs. Extensive resection may lead to nasal valve incompetence, causing obstructive symptoms associated with reduced quality of life. Numerous techniques have been…”

Excerpt; the full abstract is on PubMed.