Spreader Flap versus Spreader Graft in Dorsal Reconstruction following Hump Resection in Primary Closed Rhinoplasty

Objectives: To evaluate outcome of spreader flaps versus the spreader grafts in reconstruction of the nasal dorsum after large hump resection. This includes both functional and aesthetic aspects. Patients and Methods: Thirty patients seeking rhinoplasty for dorsal nasal hump. All surgeries were done through the closed approach. Patients were randomly divided into two groups and accordingly to the modality of nasal dorsal reconstruction after hump resection. Group (A) patients were scheduled for reconstruction using spreader grafts while in Group (B) spreader flaps were used. Evaluation included functional and aesthetic considerations. Functional subjective evaluation was done by Nasal Obstruction Symptom Evaluation (NOSE) score and objective assessment by active anterior rhinomanometry (AAR). Aesthetic evaluation included patients’ assessment of their problem according to Visual Analogue scale (VAS) while objective evaluation was done based on a suggested scoring system designed by the authors using pre and post-operative photography. The evaluating surgeons were blinded regarding the vault reconstructive modality. Results: In both groups significant improvement in both functional and aesthetic outcome - after a minimum of three months follow up- when comparing the pre and postoperative data that was obtained. There was no statistically significant difference in outcome between both groups. Conclusion: The spreader flap is a good alternative to the spreader graft in nasal dorsal reconstruction after large hump resection giving similar positive results both functionally and aesthetically however, the authors find the autospreader flap more superior to spreader graft technique as it does not require cartilage harvest.