An Algorithmic Approach to use Extended Spreader Grafts in Deviated Noses

Background

Restoration of a straight and adequately wide nasal dorsum is challenging in patients with deviated noses. Supporting a reformed septum with an extended spreader graft (ESG) is important for maintaining position.

Objective

The study aimed to describe different types of ESG and propose a comprehensive algorithm for using specific types of ESGs in rhinoplasty according to the particular type of deviated nose. It was also intended to retrospectively evaluate the long-term cosmetic results and satisfaction levels of patients who underwent rhinoplasty using different forms of ESG.

Methods

We reviewed the data of seventy-six patients who underwent rhinoplasty for deviated noses from 2019 to 2023. We noted patient demographics and types of nasal deviations. We described the types of ESGs and reviewed surgical details of their utilization, complications, and scores for patient satisfaction and surgeon assessments.

Results

The most common deviations were C or reverse C in 38% of patients. Twenty-one patients had deviations with saddle deformity. ESGs were classified into four types, of which Type-C was used in 57% of cases, followed by Type-D in 21%, Type-A in 15%, and Type-B in 7% of patients. Type-A ESG was used for type-1 deviations, Type-B ESG for type-1 deviations with saddle deformity, Type-C ESG for type-2, 3 and 4 deviations, and Type-D ESG for type-2, 3 and 4 deviations with saddle deformity. Bilateral ESGs were placed with asymmetric splinting in 38% of cases.

Conclusion

We concluded that strengthening the reconstructed septum using particular form of ESGs improves the aesthetic appearance of nose and produces consistent long-term results. The proposed guidelines will improve surgical decisions for the management of deviated noses.

Level of Evidence IV

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