Aesthetic Plastic Surgery

, Volume 43, Issue 4, pp 1006–1013 | Cite as

Role of Spreader Flaps in Rhinoplasty: Analysis of Patients Undergoing Correction for Severe Septal Deviation with Long-Term Follow-Up

  • Mauro BaroneEmail author
  • Annalisa Cogliandro
  • Rosa Salzillo
  • Alfredo Colapietra
  • Mario Alessandri Bonetti
  • Marco Morelli Coppola
  • Emile List
  • Silvia Ciarrocchi
  • Stefania Tenna
  • Paolo Persichetti
Original Article Rhinoplasty



The aim of this randomized controlled study was to analyze the long-term results of patients undergoing rhinoplasty because of severe septal deviation and to evaluate the stability of results.

Materials and Methods

The study was performed with a randomized design. Patients were randomly divided into four groups: group 1, spreader flaps were used in combination with spreader grafts; group 2, spreader flaps were used alone; group 3, spreader grafts were used alone; and group 4, neither spreader flaps nor grafts flaps were used. Patients answered the Italian version of the FACE-Q rhinoplasty module. Anthropometric measurements were performed by AutoCAD for MAC. We determined the angle of deviation, and we compared the pre- and postoperative angles and compared patient satisfaction in the four groups using the Chi-squared test for unpaired data. Two plastic surgeons reviewed all the postoperative photographs of the study patients and rated the photographs on a scale of 1 to 5.


A total of 264 patients who underwent primary rhinoplasty between January 2010 and September 2016 satisfied the inclusion criteria and were finally enrolled in this study. Anthropometric measurements revealed statistically significant differences (P < 0.01) between the preoperative and postoperative values for the angle of septal deviation in group 1 versus the other groups. Over the long-term follow-up, group 1 maintained an angle close to 180 degrees (P < 0.01). Group 1 and group 3 were more satisfied compared with groups 2 and 4 (P < 0.01). According to evaluations by the 2 reviewers, group 1 and group 3 were the most satisfactory outcomes (P < 0.01).


This was the first randomized study to show that the combined use of the spreader flap and spreader graft is the best choice for a good long-term outcome and durable correction of septal deviation.

Level of Evidence IV

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


FACE-Q NOSE-Q Rhinoplasty Nose Spreader flap Graft 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

This study was approved by the Ethics Committee of our University.

Informed Consent

Each study patient provided written informed consent before participating in the study.


  1. 1.
    East C, Kwame I, Hannan SA (2016) Revision rhinoplasty: what can we learn from error patterns? an analysis of revision surgery. Facial Plast Surg 32(4):409–415CrossRefGoogle Scholar
  2. 2.
    Calvert JW, Patel AC, Daniel RK (2014) Reconstructive rhinoplasty: operative revision of patients with previous autologous costal cartilage grafts. Plast Reconstr Surg 133:1087–1096CrossRefGoogle Scholar
  3. 3.
    Kridel RW, Soliemanzadeh P (2006) Tip grafts in revision rhinoplasty. Facial Plast Surg Clin North Am 14(331–41):viGoogle Scholar
  4. 4.
    Calvert JW, Patel AC, Daniel RK (2014) Reconstructive rhinoplasty: operative revision of patients with previous autologous costal cartilage grafts. Plast Reconstr Surg 133:1087–1096CrossRefGoogle Scholar
  5. 5.
    Wu PS, Hamilton GS 3rd (2016) Extracorporeal septoplasty: external and endonasal techniques. Facial Plast Surg 32(1):22–28CrossRefGoogle Scholar
  6. 6.
    Atespare A, Boyaci Z (2016) The use of spreader grafts in revision septoplasty. J Craniofac Surg 27:1656–1660CrossRefGoogle Scholar
  7. 7.
    Most SP, Rudy SF (2017) Septoplasty: basic and advanced techniques. Facial Plast Surg Clin North Am 25:161–169CrossRefGoogle Scholar
  8. 8.
    Kim DY, Nam SH, Alharethy SE, Jang YJ (2017) Surgical outcomes of bony batten grafting to correct caudal septal deviation in septoplasty. JAMA Facial Plast Surg 19:470–475CrossRefGoogle Scholar
  9. 9.
    Klassen AF, Cano SJ, East CA, Baker SB, Badia L, Schwitzer JA, Pusic AL (2016) Development and psychometric evaluation of the FACE-Q scales for patients undergoing rhinoplasty. JAMA Facial Plast Surg 18:27–35CrossRefGoogle Scholar
  10. 10.
    Schwitzer JA, Sher SR, Fan KL, Scott AM, Gamble L, Baker SB (2015) Assessing patient-reported satisfaction with appearance and quality of life following rhinoplasty using the FACE-Q appraisal scales. Plast Reconstr Surg 135(5):830e–837eCrossRefGoogle Scholar
  11. 11.
    Mladina R (1987) The role of maxillar morphology in the development of pathological septal deformities. Rhinology 25:199–205Google Scholar
  12. 12.
    Cottle MH, Loring RM, Fischer GG, Gaynon IE (1958) The maxilla-premaxilla approach to extensive nasal septum surgery. AMA Arch Otolaryngol 68:301–313CrossRefGoogle Scholar
  13. 13.
    Barone M, Cogliandro A, Di Stefano N, Aronica R, Tambone V, Persichetti P (2017) Linguistic validation of the “FACE-Q Rhinoplasty Module” in Italian. Eur Arch Otorhinolaryngol 274(3):1771–1772CrossRefGoogle Scholar
  14. 14.
  15. 15.
    Sheen JH (1984) Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 73:230CrossRefGoogle Scholar
  16. 16.
    Ismail A, Hussein W, Elwany S (2018) Combining spreader grafts with suture suspension for management of narrow internal nasal valve angles. Turk Arch Otorhinolaryngol 56:25–29CrossRefGoogle Scholar
  17. 17.
    Görgülü T, Özer CM, Kargi E (2015) The accordion suture technique: a modified rhinoplasty spreader flap. J Craniomaxillofac Surg 43(6):796–802CrossRefGoogle Scholar
  18. 18.
    Oneal RM, Berkowitz RL (1998) Upper lateral cartilage spreader flaps in rhinoplasty. Aesthet Surg J 37:371Google Scholar
  19. 19.
    Seyhan A (1997) Method for middle vault reconstruction in primary rhinoplasty: upper lateral cartilage bending. Plast Reconstr Surg 100:1941CrossRefGoogle Scholar
  20. 20.
    Lerma J (1995) Reconstruction of the middle vault: the “lapel” technique. Cir Plast Ibero Latinoam 21:207Google Scholar
  21. 21.
    Rohrich RJ (1999) Treatment of the nasal hump with preservation of the cartilaginous framework (Discussion). Plast Reconstr Surg 103:173CrossRefGoogle Scholar
  22. 22.
    Guyuron B, Uzzo CD, Scull H (1999) A practical classification of septonasal deviation and an effective guide to septal surgery. Plast Reconstr Surg 104:2202CrossRefGoogle Scholar
  23. 23.
    Saedi B, Amali A, Gharavis V, Yekta BG, Most SP (2014) Spreader flaps do not change early functional outcomes in reduction rhinoplasty: a randomized control trial. Am J Rhinol Allergy 28:70–74CrossRefGoogle Scholar
  24. 24.
    Fayman MS, Potgieter E (2004) Nasal middle vault support: a new technique. Aesthetic Plast Surg 28:375CrossRefGoogle Scholar
  25. 25.
    Boccieri A, Macro C, Pascali M (2005) The use of spreader grafts in primary rhinoplasty. Ann Plast Surg 55:127–131CrossRefGoogle Scholar
  26. 26.
    Arslan E, Aksoy A (2007) Upper lateral cartilage-sparing component dorsal hump reduction in primary rhinoplasty. Laryngoscope 117:990–996CrossRefGoogle Scholar
  27. 27.
    Byrd HS, Meade RA, Gonyon DL Jr (2007) Using the autospreader flap in primary rhinoplasty. Plast Reconstr Surg 119:1897–1902CrossRefGoogle Scholar
  28. 28.
    Gruber RP, Melkun ET, Woodward JF, Perkins SW (2011) Dorsal reduction and spreader flaps. Aesthet Surg J 31:456–464CrossRefGoogle Scholar
  29. 29.
    Moubayed SP, Most SP (2016) The autospreader flap for midvault reconstruction following dorsal hump resection. Facial Plast Surg 32(1):36–41CrossRefGoogle Scholar
  30. 30.
    Kovacevic M, Wurm J (2015) Spreader flaps for middle vault contour and stabilization. Facial Plast Surg Clin North Am 23(1):1–9CrossRefGoogle Scholar
  31. 31.
    Wurm J, Kovacevic M (2013) A new classification of spreader flap techniques. Facial Plast Surg 29:506–514CrossRefGoogle Scholar
  32. 32.
    Sowder JC, Thomas AJ, Gonzalez CD, Limaye NS, Ward PD (2017) Use of spreader flaps without dorsal hump reduction and the effect on nasal function. JAMA Facial Plast Surg 19(4):287–292CrossRefGoogle Scholar
  33. 33.
    Guo BY, Liao DH, Li XY, Zeng YJ, Yang QH (2007) Age and gender related changes in biomechanical properties of healthy human costal cartilage. Clin Biomech (Bristol, Avon) 22(3):292–297CrossRefGoogle Scholar
  34. 34.
    Alkan Z, Acioglu E, Yigit O, Bekem A, Azizli E, Unal A, Sahin F (2012) Determining the most suitable costal cartilage level for rhinoplasty: an experimental study. Otolaryngol Head Neck Surg 146(3):377–381CrossRefGoogle Scholar
  35. 35.
    Griffin MF, Premakumar Y, Seifalian AM, Szarko M, Butler PE (2016) Biomechanical characterisation of the human auricular cartilages; implications for tissue engineering. Ann Biomed Eng 44:3460–3467CrossRefGoogle Scholar
  36. 36.
    Eames BF, Schneider RA (2008) The genesis of cartilage size and shape during development and evolution. Development 135:3947–3958CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  • Mauro Barone
    • 1
    • 2
    Email author
  • Annalisa Cogliandro
    • 1
    • 2
  • Rosa Salzillo
    • 1
  • Alfredo Colapietra
    • 1
  • Mario Alessandri Bonetti
    • 1
  • Marco Morelli Coppola
    • 1
  • Emile List
    • 3
  • Silvia Ciarrocchi
    • 1
  • Stefania Tenna
    • 1
  • Paolo Persichetti
    • 1
    • 2
  1. 1.Plastic and Reconstructive Surgery UnitCampus Bio-Medico University of RomeRomeItaly
  2. 2.Research group “To be and to appear: Objective indication to Plastic Surgery” of Campus Bio-Medico University in RomeRomeItaly
  3. 3.Universitair Medisch Centrum UtrechtUtrechtThe Netherlands

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