Spreader Graft vs Spreader Flap in Rhinoplasty: A Systematic Review and Meta-Analysis of Aesthetic and Functional Outcomes

Overview

Insufficient support of the middle of the nose during rhinoplasty can cause significant complications, and the spreader graft is described as the gold standard for rebuilding it. The spreader flap uses the patient's own upper cartilages folded inward instead of adding a graft. This systematic review and meta analysis compared the two on appearance and breathing outcomes, searching PubMed, Google Scholar and the Cochrane Library up to April 2021.

Sections of note

• Systematic review and meta analysis; 10 articles with a total of 567 cases, mean age 27.7 years, range 18 to 65.
• Factors evaluated were restoration of the bridge aesthetic lines, satisfaction rate, internal nasal valve angle improvement, the NOSE scale and active anterior rhinomanometry.
• No statistically significant difference was found between the two techniques for restoration of the dorsal aesthetic lines.
• No significant difference was found for internal nasal valve angle improvement.
• No significant difference was found on the NOSE scale or on rhinomanometry.
• Satisfaction rate favoured the spreader graft significantly.
• The authors conclude that in appropriately selected patients there is no significant difference between the techniques.

What it means for a patient

• Both techniques kept the airway open equally well by both patient questionnaire and objective airflow testing.
• The graft scored better on satisfaction despite no measured difference in the outcomes assessed.
• Using the patient's own folded cartilage avoids spending septal cartilage that may be needed elsewhere.
• Ten studies with 567 patients pooled from non randomized work carries the limitations of the underlying literature.

Why this paper matters

Rebuilding the middle of the nose after hump removal is a required step, and the choice between adding a graft and folding existing cartilage is made in every such case. This meta analysis finds them equivalent on measured outcomes. Why satisfaction differed without a measurable difference is unexplained.

Terms

• Spreader graft: a cartilage strip placed beside the septum to widen the internal breathing valve.
• Spreader flap or autospreader: the patient's own upper cartilages folded inward to serve the same purpose.
• Mid vault: the middle third of the nose, between the bony bridge and the tip.
• Internal nasal valve: the narrowest part of the nasal airway.
• Rhinomanometry: a test measuring pressure and airflow through the nose.
• NOSE scale: the Nasal Obstruction Symptom Evaluation questionnaire.