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

Straightening Crooked Nose with Precise Bone Refining

Objectives: Crooked noses pose significant challenges in rhinoplasty due to their complex anatomy, particularly in the bony vault. Traditional methods focus on osteotomies but often do not equalize the lengths of the nasal bones. This study introduces a novel technique using otologic drills to address this problem by shortening the longer nasal bone and aligning the nasion-rhinion line at the midline. Methods: A Goodman incision was made to access the nasal bones under general anesthesia. Otologic drills were used for lateral and transverse ostectomies to shorten the longer nasal bone and reposition the nasal bone vault. Follow-ups were conducted 3, 6, and 12 months after surgery. Results: Of 48 cases (22 men and 26 women), 47 achieved satisfactory results with a straightened nose. One case showed a slight deviation after surgery, which did not require revision. Discussion: The technique effectively addresses the issue of asymmetric nasal bone lengths, which traditional methods often overlook. Using otologic drills allows precise bone cutting, contributing to long-lasting outcomes. Conclusions: Otologic drill-assisted ostectomies effectively equalize nasal bone lengths, improving nasal symmetry. More research with larger case series and long-term follow-up is needed to confirm the efficacy and safety of this technique, including potential applications in closed rhinoplasty.

Radiographic Study of the Nasal Valve in Different CT Evaluation Method in Asian Patients with Unilateral Cleft Lip Nose

OBJECTIVE(S)

It was the first study to apply and compare two CT methods to assess the validity and clinical significance of structural alterations of the nasal valve in patients with cleft lip nose for assessing nasal ventilation disturbance.

METHODS

The study collected data from the NOSE score, as well as internal nasal valve area, internal nasal valve angle, external nasal valve area, and septal deviation angle, to evaluate the differences and correlations between those factors in patients with cleft lip and nose.

RESULTS

There were significant differences among INV transverse and coronal area and INV angle on different axial standardized planes between clefted side and non-clefted side. There were statistically significant negative correlations between NOSE scores and those indicators of standard plane and acoustic-axis standardized coronal plane. NOSE score and NSD angle were the indicators of significant differences in the measured data of different complications groups (p = 0.002, p = 0.017). The correlation comparison showed that two standardized CT imaging transverse planes have similar correlations in NOSE score, NSD angle, and complications.

CONCLUSION

The results of the two CT evaluation methods showed that there was a significant difference in nasal valve area on the cleft and non-cleft sides, which was significantly associated with nasal ventilation disturbance. The CT evaluation method based on standard axial 3D reconstruction is more convenient to use in the clinic, can be used for pre-surgical evaluation of nasal repair in patients with secondary nasal deformities of unilateral cleft lip, and is valuable for treatment.

LEVEL OF EVIDENCE IV

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Comparison of the Effects of Spreader Graft Versus Spreader Flap on Nasal Valve Angle in Open Approach Rhinoplasty

OBJECTIVE

This study aimed to compare the spreader graft and flap techniques, which are used in nasal valve surgery, based on measurements of nasal valve angles using computed tomography.

MATERIAL AND METHOD

In this retrospective study, all patients' right and left internal nasal valve angles were measured from coronal computed tomography images taken preoperatively and in the third postoperative month. A paired t-test and independent t-test were used to compare continuous numerical variables.

RESULTS

There were 52 patients with 104 valves in the spreader flap group and 54 patients with 108 valves in the spreader graft group, with a mean age of 27.76 ± 8.16 years. The angles were found to be statistically significantly higher in the postoperative period (p<0.001) in all patients. While the angles did not differ significantly between the flap and graft groups in the preoperative period, they were significantly higher in the flap group in the postoperative period (p<0.001).

DISCUSSION

It is essential to preserve nasal valve function in rhinoplasty. The findings show that a spreader flap is superior to a spreader graft, although both techniques increase internal nasal valve function.

LEVEL OF EVIDENCE III

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 www.springer.com/00266 .