Comparison of the Effects of Spreader Graft Versus Spreader Flap on Nasal Valve Angle in Open Approach Rhinoplasty

Koplay TG, Inan I, Ozer H.

PubMed 37640816 Publisher (DOI)Free full text (PMC)

What this paper says

On CT scans three months after open rhinoplasty, both spreader grafts (54 patients) and spreader flaps (52 patients) widened the internal nasal valve angle, and the flap widened it significantly more.

Overview

After hump removal, the internal nasal valve must be kept open with either a separate cartilage graft or by folding the upper lateral cartilage inward as a flap. The Turkish authors retrospectively measured right and left internal valve angles on coronal CT before surgery and at three months in both groups.

Sections of note

Spreader flap group: 52 patients, 104 valves; spreader graft group: 54 patients, 108 valves; mean age 27.76.
Valve angles increased significantly after surgery in all patients (p < 0.001).
No difference between groups before surgery.
Postoperative angles were significantly higher in the flap group (p < 0.001).
Level of Evidence III.

What it means for a patient

Both techniques protect breathing after hump removal; in this study the flap opened the valve wider.
The flap uses the patient's own upper lateral cartilage and needs no separate graft.
Three-month CT angles are a structural measure; breathing symptoms were not reported.

Why this paper matters

It is a direct, imaging-based comparison of the two main mid-vault reconstruction methods. Limits: retrospective, 3-month follow-up, no symptom scores.

Terms

Internal nasal valve: the angle between the septum and upper lateral cartilage, the narrowest part of the airway.
Spreader graft: a cartilage strip placed between septum and upper lateral cartilage.
Spreader (autospreader) flap: the upper lateral cartilage folded inward to act as its own spreader.
Coronal CT: a front-on cross-sectional scan slice.

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

Abstract

Objective: This study aimed to compare the spreader graft and flap techniques, which are used in nasal valve surgery, based on measurements of nasal valve angles using computed tomography.

Material And Method: In this retrospective study, all patients' right and left internal nasal valve angles were measured from coronal computed tomography images taken preoperatively and in the third postoperative month. A paired t-test and independent t-test were used to compare continuous numerical variables.

Results: There were 52 patients with 104 valves in the spreader flap group and 54 patients with 108 valves in the spreader graft group, with a mean age of 27.76 ± 8.16 years. The angles were found to be statistically significantly higher in the postoperative period (p<0.001) in all patients. While the angles did not differ significantly between the flap and graft groups in the preoperative period, they were significantly higher in the flap group in the postoperative period (p<0.001).

Discussion: It is essential to preserve nasal valve function in rhinoplasty. The findings show that a spreader flap is superior to a spreader graft, although both techniques increase internal nasal valve function.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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