Extended Spreader Graft Placement Before Lateral Nasal Osteotomy

The extended spreader graft technique in septorhinoplasty is presented. The procedure involves applying spreader grafts before lateral osteotomies to support the whole osteocartilaginous vault. This study enrolled 51 patients who had undergone open septorhinoplasty between January 2010 and March 2012. The dorsal width ratio (DWR) was calculated for each patient by dividing the keystone width score by the intercanthal width score. The preoperative DWR scores classified 32 of the 51 noses as normal, six noses as narrow, and 13 noses as wide. All the patients with a nose classified as narrow preoperatively had a nose with a normal width postoperatively. All but one patient who had a normal preoperative DWR score also had a normal DWR score postoperatively. Of the 13 patients who had a wide nose preoperatively, seven were classified in the normal-width group postoperatively. Although the remaining six patients had a positive DWR score change (DWR closer to 0.50), they still were in the wide-nose group postoperatively. All but three patients were satisfied with their cosmetic and aesthetic results. Inverted-V or open-roof deformities were not observed. For all 18 patients in the normal nasal width group preoperatively (18/32), the nasal dorsum seemed wide after lateral osteotomies due to the spacing effect of the graft. As a result of medializing the bones, the caudal end of the graft became palpable. Although the graft position was checked perioperatively, at the postoperative 6-month follow-up assessment, three patients had palpable cartilages in the keystone area, one of which needed a surgical revision. Extended spreader grafts applied before lateral nasal osteotomies can support the entire nasal dorsum, including the bony vault. This spacing effect could be highly advantageous for both narrow and wide noses. In narrow noses, these grafts prevent further narrowing of the osteocartilaginous vault and support the dorsal aesthetic lines. In wide noses, extended spreader grafts fill the bone gap before lateral osteotomy and help to prevent open-roof deformity. In addition, fixing the upper lateral cartilages before lateral osteotomies might further prevent bone collapses, even after premature fractures. In normal-width noses, after completion of the lateral osteotomies, the bone gap usually does not persist, and nasal bones push the cranial end of the spreader graft dorsally. Therefore, in normal-width noses, extending the graft along the bony gap is not necessary, and the use of extended spreader grafts is not preferred.

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