Mini spreader grafts: a new technique associated with reshaping of the nasal tip.

Abstract

Reshaping of the nasal tip by excision of a strip of cartilage from the cephalic portion of the lateral crura is a commonly used procedure. This surgical technique is not completely free of risk, above all when associated with hump excision, as is often the case. It can lead to incompetence of the internal nasal valve and thus to postoperative respiratory disorders. The author proposes a new surgical technique capable of preventing these problems and improving the degree of nasal tip rotation, where necessary. The method combines resection of the cephalic portion of the lateral crura with its attachment on either side of the dorsal septum as two "mini spreader grafts." Forty patients were treated by means of this technique. Rhinomanometric data demonstrate an improvement in total mean nasal airflow, and no worsening was registered in any case. Correction of droopy tip was also achieved with optimal cephalic rotation of the tip. Although small in size, the grafts are very important in functional terms in that they restore a physiologic angle in the area of the internal nasal valve between the septum and the upper lateral cartilages. The preservation of a fibromucous connection between the grafts and the two lateral crura from which they are taken has an aesthetic effect. To this end, it is sufficient to secure the two mini spreader grafts to the septum in a more cephalic position to obtain a greater degree of rotation of the tip complex.