The contralateral upper lateral cartilage may be secured to the remnant dorsal strut or, in cases of internal valve collapse, a spreader graft
(figure 4) may be placed to assist in support of the neoseptum.
Previously, the viability of using calcium hydroxyapatite (Radiesse) as a spreader graft
has been documented as a treatment for internal nasal valve collapse.
Spreader graft placement is indicated to: (1) correct internal valve collapse; (2) bridge and strengthen a long, narrow middle vault in patients with short nasal bones; (3) correct a lack of dorsal support of the lateral nasal walls; (4) widen the middle one-third of the nose; (5) straighten or stabilize a high dorsally deviated septum; and (6) create straight dorsal aesthetic lines (figure 1).
Placement of an endonasal spreader graft begins with the infiltration of 1% lidocaine with 1:50,000 epinephrine into the submucoperichondrial plane along the dorsal cartilaginous and osseous septum.
According to Pontius and Williams in this month's Facial Plastic Surgery Clinic, when an endonasal spreader graft
is being placed during rhinoplasty, the pocket created for the spreader graft
should only be--wider than the Freer elevator used to create the pocket.
Finally, a unilateral spreader graft
that spans the transection is placed along the cut dorsal septum on the side opposite the suture.
The use of a single dorsal onlay spreader graft
can correct both internal valve collapse and concurrent saddle-nose deformity (figure 1).
We performed open septorhinoplasty and placed a batten graft and a spreader graft
on the right.
Butterfly grafts, alar batten grafts, flaring sutures, suspension sutures, and spreader grafts
were used as needed.
A caudal septal extension and spreader grafts
were fashioned to correct the aforementioned deficiency and provide central support to the nose.
Graft stability can be enhanced by using two splinting or extended spreader grafts
The remaining portions of the upper lateral cartilages were also resuspended to spreader grafts