Facial Plast Surg 2016; 32(01): 036-041
DOI: 10.1055/s-0035-1570324
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Autospreader Flap for Midvault Reconstruction following Dorsal Hump Resection

Sami P. Moubayed
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
,
Sam P. Most
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
10. Februar 2016 (online)

Abstract

Dorsal hump reduction without adequate reconstitution of the midvault can often result in cosmetic or functional problems. One of the simplest techniques to avoid these problems is the use of the excess upper lateral cartilage to reconstruct the midvault (the spreader flap or autospreader). Herein we outline the history of the technique and present the specific indications and contraindications, as well as describe our method for achieving it successfully. Case studies are presented with the specific indications. Grafting alternatives to the spreader flap are also outlined. The spreader flap technique offers multiple advantages, including maximal use of local tissues, simplicity, and airway preservation. Disadvantages are the use of an external approach and the inability to use it alone in the presence of severe asymmetries.

 
  • References

  • 1 Sykes JM, Tapias V, Kim JE. Management of the nasal dorsum. Facial Plast Surg 2011; 27 (2) 192-202
  • 2 Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 1984; 73 (2) 230-239
  • 3 Most SP. Trends in functional rhinoplasty. Arch Facial Plast Surg 2008; 10 (6) 410-413
  • 4 Byrd HS, Meade RA, Gonyon Jr DL. Using the autospreader flap in primary rhinoplasty. Plast Reconstr Surg 2007; 119 (6) 1897-1902
  • 5 Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg 2004; 130 (2) 157-163
  • 6 Guyuron B, Behmand RA. Caudal nasal deviation. Plast Reconstr Surg 2003; 111 (7) 2449-2457 , discussion 2458–2459
  • 7 Yagmur C, Kelahmetoğlu O, Akbaş H. Spreader flap correction of dorsal septal deviations. Aesthet Surg J 2015; 35 (3) 345-348
  • 8 de Pochat VD, Alonso N, Figueredo A, Ribeiro EB, Mendes RR, Meneses JV. The role of septal cartilage in rhinoplasty: cadaveric analysis and assessment of graft selection. Aesthet Surg J 2011; 31 (8) 891-896
  • 9 Brockhoff II HC, Morris CD, Throckmorton GS, Finn R. Anatomic analysis of the conchal bowl cartilage. J Oral Maxillofac Surg 2014; 72 (11) 2248-2255
  • 10 Gruber RP, Park E, Newman J, Berkowitz L, Oneal R. The spreader flap in primary rhinoplasty. Plast Reconstr Surg 2007; 119 (6) 1903-1910
  • 11 Fomon S, Gilbert JG, Caron AL, Segal Jr S. Collapsed ala: pathologic physiology and management. Arch Otolaryngol 1950; 4 (51) 465-484
  • 12 Oneal RM, Berkowitz RL. Upper lateral cartilage spreader flaps in rhinoplasty. Aesthet Surg J 1998; 18 (5) 370-371
  • 13 Seyhan A. Method for middle vault reconstruction in primary rhinoplasty: upper lateral cartilage bending. Plast Reconstr Surg 1997; 100 (7) 1941-1943
  • 14 Lerma J. The “lapel” technique. Plast Reconstr Surg 1998; 102 (6) 2274-2275
  • 15 Ishida J, Ishida LC, Ishida LH, Vieira JC, Ferreira MC. Treatment of the nasal hump with preservation of the cartilaginous framework. Plast Reconstr Surg 1999; 103 (6) 1729-1733 , discussion 1734–1735
  • 16 Fayman MS, Potgieter E. Nasal middle vault support: a new technique. Aesthetic Plast Surg 2004; 28 (6) 375-380 , discussion 381–382
  • 17 Wurm J, Kovacevic M. A new classification of spreader flap techniques. Facial Plast Surg 2013; 29 (6) 506-514
  • 18 Görgülü T, Özer CM, Kargi E. The accordion suture technique: a modified rhinoplasty spreader flap. J Craniomaxillofac Surg 2015; 43 (6) 796-802
  • 19 Manavbaşı YI, Başaran I. The role of upper lateral cartilage in dorsal reconstruction after hump excision: section 1. Spreader flap modification with asymmetric mattress suture and extension of the spreading effect by cartilage graft. Aesthetic Plast Surg 2011; 35 (4) 487-493
  • 20 Gruber RP, Melkun ET, Woodward JF, Perkins SW. Dorsal reduction and spreader flaps. Aesthet Surg J 2011; 31 (4) 456-464
  • 21 Yoo S, Most SP. Nasal airway preservation using the autospreader technique: analysis of outcomes using a disease-specific quality-of-life instrument. Arch Facial Plast Surg 2011; 13 (4) 231-233
  • 22 Saedi B, Amali A, Gharavis V, Yekta BG, Most SP. Spreader flaps do not change early functional outcomes in reduction rhinoplasty: a randomized control trial. Am J Rhinol Allergy 2014; 28 (1) 70-74
  • 23 Rhee JS, Weaver EM, Park SS , et al. Clinical consensus statement: diagnosis and management of nasal valve compromise. Otolaryngol Head Neck Surg 2010; 143 (1) 48-59
  • 24 Lee MK, Most SP. Evidence-based medicine: rhinoplasty. Facial Plast Surg Clin North Am 2015; 23 (3) 303-312
  • 25 Stewart MG, Smith TL, Weaver EM , et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg 2004; 130 (3) 283-290
  • 26 Chambers KJ, Horstkotte KA, Shanley K, Lindsay RW. Evaluation of improvement in nasal obstruction following nasal valve correction in patients with a history of failed septoplasty. JAMA Facial Plast Surg 2015; 17 (5) 347-350
  • 27 André RF, Paun SH, Vuyk HD. Endonasal spreader graft placement as treatment for internal nasal valve insufficiency: no need to divide the upper lateral cartilages from the septum. Arch Facial Plast Surg 2004; 6 (1) 36-40
  • 28 Huang C, Manarey CR, Anand VK. Endoscopic placement of spreader grafts in the nasal valve. Otolaryngol Head Neck Surg 2006; 134 (6) 1001-1005
  • 29 Park SS. The flaring suture to augment the repair of the dysfunctional nasal valve. Plast Reconstr Surg 1998; 101 (4) 1120-1122
  • 30 Palacín JM, Bravo FG, Zeky R, Schwarze H. Controlling nasal length with extended spreader grafts: a reliable technique in primary rhinoplasty. Aesthetic Plast Surg 2007; 31 (6) 645-650
  • 31 Lohuis PJ. Advanced Caucasian and Mediterranean Rhinoplasty. Amsterdam: Kugler Publications; 2014
  • 32 Clark JM, Cook TA. The ‘butterfly’ graft in functional secondary rhinoplasty. Laryngoscope 2002; 112 (11) 1917-1925
  • 33 Azizzadeh B. Master Techniques in Rhinoplasty. Philadelphia, PA: Saunders; 2011
  • 34 Timmer FC, Roth JA, Börjesson PK, Lohuis PJ. The lateral crural underlay spring graft. Facial Plast Surg 2013; 29 (2) 140-145
  • 35 Lieberman DM, Most SP. Lateral nasal wall suspension using a bone-anchored suture technique. Arch Facial Plast Surg 2010; 12 (2) 113
  • 36 Weissman JD, Most SP. Radiofrequency thermotherapy vs bone-anchored suspension for treatment of lateral nasal wall insufficiency: a randomized clinical trial. JAMA Facial Plast Surg 2015; 17 (2) 84-89
  • 37 Seren E. A new surgical method of dynamic nasal valve collapse. Arch Otolaryngol Head Neck Surg 2009; 135 (10) 1010-1014