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Spreader Graft Placement Found Comparable in Functional Outcome in Patients with Nasal Obstruction

by Linda Kossoff •

What is the level of satisfaction with nasal appearance and correction of nasal airway obstruction (NAO) in patients who underwent septorhinoplasty (SRP) with spreader graft placement without upper lateral cartilage release, and how does it compare to traditional upper lateral cartilage release?

BOTTOM LINE

Septorhinoplasty with spreader graft placement with and without upper lateral cartilage release provides clinically and statistically significant improvement with no significant difference in functional outcome.

BACKGROUND: Structural NAO is commonly caused by septal deviation, turbinate hypertrophy, and/or nasal valve dysfunction. Performing SRP for NAO may require using spreader grafts to treat internal valve narrowing. This can cause nasal dorsum widening, as upper lateral cartilages are commonly released from the dorsum of the septum. Preservation rhinoplasty is becoming a popular option.

STUDY DESIGN: Prospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston.

SYNOPSIS: A total of 559 patients who underwent SRP with spreader graft placement with upper lateral cartilage release and 30 patients who underwent SRP with spreader graft placement without release between 2012 and 2020 were administered the Nasal Obstruction Symptom Evaluation (NOSE), FACE-Q Satisfaction with Nose, and FACE-Q Social Functioning scales pre- and post-operatively. Pre- and post-operative NOSE, FACE-Q, and negative inspiratory force (NIF) scores and changes were compared between groups. In the release cohort, 155 patients underwent cosmetic SRP, compared to two patients in the nonrelease cohort. Results demonstrated that SRP with spreader graft placement with and without upper lateral cartilage release provided clinically and statistically significant improvement, with no significant difference in functional outcome. There was no significant difference between groups in mean improvement of NOSE, FACE-Q, and NIF scores at time of last follow-up. These findings suggest that upper lateral cartilages do not need to be released to achieve functional improvement. Study limitations included the involvement of a single tertiary academic center with a single surgeon.

CITATION: Weitzman RE, Gadkaree SK, Justicz NS, et al. The impact of upper lateral cartilage release on patient-perceived nasal appearance and obstruction. Laryngoscope. 2022;132:1189-1195.