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Spreader Graft: A Method of Reconstructing the Roof of the Middle Nasal Vault Following Rhinoplasty

Sheen, Jack H.·1984·Plastic and Reconstructive Surgery

DOI 10.1097/00006534-198402000-00013

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Abstract

Los Angeles, Calif. From the Department of Surgery, Division of Plastic Surgery, at the UCLA School of Medicine. 9201 Sunset Boulevard, Suite 814 Los Angeles, Calif. 90069

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Items 301–400 of 619

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“Since the introduction of spreader grafts by Sheen [17] in 1984, they have been widely used to support the middle vault.”
BackgroundMethodInfluential
What are some tips and pearls for preserving and improving nasal function when performing a cosmetic rhinoplasty?
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“Externally, the rhinoplasty surgeon should note a patient with a narrow middle vault and short nasal bones, as he or she is at increased risk of internal nasal valve collapse if this is not appropriately recognized and addressed [2,3].”
BackgroundMethod
A Cadaveric Study Comparing the Efficacy of the Sheen Spreader Graft and the Fulcrum Spreader Graft
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Osseocartilaginous Vault
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“The most frequently used method for a nasal valve surgery to date is the spreader grafts application described by Sheen.(12) Using these grafts, the narrowed nasal valve region is widened and the middle vault aesthetic deformities restored.”
Method
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“Furthermore, using this method the middle nasal vault can be straightened.(13) In addition, a thicker spreader graft would support deformed upper lateral cartilage on the concave site.”
Method
Nasal Obstruction Considerations in Cosmetic Rhinoplasty
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Structure Rhinoplasty of the Long Nose
Ali, A., Elbarbary, A. S., & Farag, M. (2011) · Aesthetic Plastic Surgery · doi:10.1007/s00266-011-9707-y · Cited by 6
“Therefore, spreader grafts were used mainly to avoid any functional compromise [28].”
Method
A Patient Seeking Aesthetic Revision Rhinoplasty and Correction of Nasal Obstruction
Becker, D. G., Bloom, J. D., & Gudis, D. A. (2009) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2009.03.001 · Cited by 6
The Stairstep Graft
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A novel technique for spreader graft placement without dorsum resection during septoplasty
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Three Important Considerations in Posttraumatic Rhinoplasty
Low, B. C., Massoomi, N., & Fattahi, T. (2009) · The American Journal of Cosmetic Surgery · doi:10.1177/074880680902600107 · Cited by 6
The Composite Spreader Flap
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“In the keystone area, (1) the dorsal nasal septum has a T-shaped structure that acts as a spacer/lever for the overriding ULCs, (2) the ULCs flare laterally, and (3) ULCs underride the dorsal bony cap for a variable distance.”
BackgroundMethodInfluential
Spreader Graft for Severe Deviation of Nasal Septum with Obstruction of the Internal Nasal Valve: Clinical and Functional Results
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Overly wide cartilaginous middle vault
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Correction of deviated nose
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“However, functional and cosmetic features of the nose seem to be closely intertwined; hence, utilizing the correct surgical approach will technically achieve the desired functional and cosmetic outcomes simultaneously [5].”
BackgroundMethod
Balanced Cantilever Graft for Supporting the Cartilaginous Side Wall of Nose
Raghavan, U., Daoud, M., Heywood, E. G., & Ullas, G. (2021) · Aesthetic Surgery Journal · doi:10.1093/asj/sjab212 · Cited by 5
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“Spreader graft was designed to address the aesthetics of the dorsal lines and the problem of nasal valve collapsingwith subsequent nasal obstruction [11].”
BackgroundInfluential
History of Cosmetic Rhinoplasty
Shiffman, M. A. (2013) · Springer eBooks · doi:10.1007/978-3-642-28053-5_11 · Cited by 5
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Docile Splay graft for middle vault reconstruction
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Management of the Internal Nasal Valve
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Update in the management of the middle vault in rhinoplasty
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“The placement of spreader graphs was among the first interventions proposed to preserve the middle vault in rhinoplasty [12].”
Background
A Promising New Technique for Correcting a Deviated Nose: Partial Disarticulation of Keystone Area
Cabbarzade, C. (2019) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000005678 · Cited by 5
“Various methods have been described for the correction of septum.(2,3,4,5,6,7,8,9) Availability of a wide range of methods actually arises from the fact that not even a single method is capable of dealing with the problems with minimum risks.”
Method
Three-Dimensional Computed Tomography Volume and Physiology of Nasal Cavity After Septhorhinoplasty
Tuğrul, S., Doğan, R., Hassouna, H. N. H., et al. (2019) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000005730 · Cited by 5
“Spreader graft is widely used in SRP operations for the protection and reconstruction of the middle nasal roof.(1) In another study, postoperative PNIF values increased in all except for 3 of 23 patients (86.”
Background
Spreader Graft Placement: An Effective Procedure for Alleviation of Internal Nasal Valve Collapse
Garg, L. N., Singh, N. K., Kappagantu, K. M., & Yadav, A. (2021) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2021.05.034 · Cited by 5
Oblique Septal Crossbar Graft for Anterior Septal Angle Reconstruction
Aziz, Z. S., Brenner, M. J., & Putman, H. C. (2010) · Archives of Facial Plastic Surgery · doi:10.1001/archfaci.2010.92 · Cited by 10
“These grafts straighten the nasal midvault, reestablish aesthetic contours, reinforce the dorsal septum, and reconstitute the function of the internal nasal valve.(10) Spreader grafts also resist the tendency for midvault collapse, the cause of inverted-V deformity, and can be used to close an open roof deformity afte…”
DISPELLING THE PROPAGATED MYTH: A QUIZZICAL LOOK AT THE INTERNAL NASAL VALVE
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Discussion
Toriumi, D. M. (1996) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-199607000-00008 · Cited by 5
Therapie der Nasenklappenstenose
Heppt, W. J., Hildebrandt, T., & Vent, J. (2015) · HNO · doi:10.1007/s00106-014-2962-x · Cited by 4
Inverted-V Deformity: An Anatomic Study
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A Novel Technique for Spreader Flap by Folding the Dorsal Hump in Patients Undergoing Primary Rhinoplasty
AlAwadh, I., Bogari, A., Assiri, H., et al. (2022) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000008847 · Cited by 4
The Use of a Unilateral Curved Spreader Graft in the Management of Crooked Nose Deformity
Elsayed, A. I., El-Bahrawy, A. T., Sorour, S., et al. (2023) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000003724 · Cited by 4
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Burks, C. A., & Lyford-Pike, S. (2024) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2024.07.018 · Cited by 4
Surgery for Nasal Valve Compromise
Chang, J. (2014) · Korean Journal of Otorhinolaryngology - Head and Neck Surgery · doi:10.3342/kjorl-hns.2014.57.4.214 · Cited by 4
Alar cartilage—an alternative for spreader graft in primary rhinoplasty
Uebel, C. O., & Ramos, R. M. (2017) · European Journal of Plastic Surgery · doi:10.1007/s00238-017-1336-5 · Cited by 4
“Described by Sheen in 1984 [33], the spreader graft is considered a well-established technique to improve the Fig.”
Background
Four-Step Spreader Flap: The Pull-Twist-Turn Technique
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“8,9 The four-step spreader flap technique described by the authors offers a simple, reproducible method of shaping the dorsal midvault while preserving internal valve function, especially in a primary rhinoplasty with the following: (1) greater than 3 mm of dorsal hump reduction; (2) strong upper lateral cartilages; a…”
Method
Surgical Treatment of Dynamic Nasal Collapse
Ji, K. S. Y., & Krane, N. A. (2022) · Facial Plastic Surgery · doi:10.1055/a-1825-2610 · Cited by 4
Anatomical Comparison of Minimally Invasive Nasal Valve Procedures
Weeks, D. M., Walker, D. D., & Dutton, J. M. (2012) · Archives of Facial Plastic Surgery · doi:10.1001/archfaci.2012.24 · Cited by 9
“The spreader graft technique used was first de-A scribed by Sheen.”
Mucoperichondrial Spreader Flap Application for Middle Vault Reconstruction in Rhinoplasty: A Review of 857 Cases
Cabbarzade, C. (2021) · Aesthetic Surgery Journal · doi:10.1093/asj/sjaa333 · Cited by 4
Late salvage of nasal injuries
Rohrich, R. J., & Adams, W. P. (1998) · Operative Techniques in Plastic and Reconstructive Surgery · doi:10.1016/s1071-0949(98)80040-1 · Cited by 4
Practical Classification of Upper Lateral Cartilage in Middle Vault Asymmetry
Hafezi, F., Naghipour, R., Naghibzadeh, B., et al. (2020) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000006815 · Cited by 4
Nasal Valve Surgery
Kenyon, G. S., & Andrew, P. (2009) · Springer eBooks · doi:10.1007/978-3-540-74380-4_5 · Cited by 4
Correction of the Over-resected Nose
Nassimizadeh, A., Nassimizadeh, M., Wu, J., et al. (2019) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2019.07.003 · Cited by 4
Comparative Analysis of Spreader Grafts and Spreader Flaps on Intranasal Drug Delivery Efficiency to Posterolateral Nasal Wall
Kim, M. H., Martin, H. L., Avashia, Y. J., Sicard, R. M., Chiang, H., Woodard, C. R., Marcus, J. R., & Frank-Ito, D. O. (2025) · FACE · doi:10.1177/27325016241310616 · Cited by 3
“6,7 8-11 Of note, these procedures are commonly associated with dorsal hump reduction.”
Endonasal Placement of Spreader Grafts
Manavbasi, I., & Ağaoğlu, G. (2007) · Plastic & Reconstructive Surgery · doi:10.1097/01.prs.0000259792.91511.c8 · Cited by 3
Triangular Resection of the Upper Lateral Cartilage for Middle Vault Deviation
Ryu, G., Seo, M. Y., Lee, K. E., et al. (2018) · Clinical and Experimental Otorhinolaryngology · doi:10.21053/ceo.2017.01816 · Cited by 3
Major Structural Airway Pathologies of Patient Complaining Nasal Obstruction: Analysis of Frequency, Preoperative Complaints and Benefit from Surgery
Üstün, G. G., Öztürk, S., Gürsoy, K., Ergün, E., Dağ, O., & Koçer, U. (2019) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000005554 · Cited by 3
Counter Autografting of Dorsal Septum in Crooked Nose
Yağmur, Ç., Evin, N., Kelahmetoğlu, O., Küçüker, İ., Kodalak, E. A., & Demir, A. (2020) · Aesthetic Plastic Surgery · doi:10.1007/s00266-020-01756-5 · Cited by 3
An Alternative Method for Midvault Restoration: “T-Splay Graft”
Kopal, C., & Kapı, E. (2021) · Aesthetic Plastic Surgery · doi:10.1007/s00266-021-02632-6 · Cited by 3
Grafts
Daniel, R. K., & Pálházi, P. (2018) · Springer eBooks · doi:10.1007/978-3-319-67314-1_6 · Cited by 3
Using the Disruptive Score to Identify Publications That Changed Plastic Surgery Practice
Neubauer, D. C., Blum, J. D., Labou, S. G., et al. (2022) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000003144 · Cited by 3
Functional and esthetic outcomes of functional rhinoplasty for internal nasal valve dysfunction in Asian patients
Jung, H. J., Park, M. W., Shim, W. S., & Wee, J. H. (2024) · Brazilian Journal of Otorhinolaryngology · doi:10.1016/j.bjorl.2024.101430 · Cited by 3
Modification of nasal pyramid in rhinoplasty: current state of issue
Gorbunov, S. A., Zholtikov, V., Rusetsky, Y. Y., & Manturova, N. E. (2024) · Russian Rhinology · doi:10.17116/rosrino202432021126 · Cited by 3
Evaluation of postoperative patient satisfaction after covering the nasal dorsum with upper lateral cartilage: “upper lateral closing”
Çağıcı, C. A. (2017) · Brazilian Journal of Otorhinolaryngology · doi:10.1016/j.bjorl.2017.10.011 · Cited by 3
The Middle Eastern–Mediterranean Nose
Çerkeş, N. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-41745-7.00018-7 · Cited by 3
Evaluation of the use of Different Spreader Techniques in Primary Open Septorinoplasty in Terms of Nasal and Olfactory Functions
Bilgin, E., Çelik, E. K., Baklacı, D., et al. (2021) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000007485 · Cited by 3
“Spreader grafts were first described by Sheen for disrupted medial roof reconstruction while Oneal and Berkowitz defined spreader flaps as an alternative to medial roof reconstruction.(2,3) On the other hand, some authors do not recommend the routine use of spreader techniques in all septorhinoplasty surgeries.”
Background
The Impact of Upper Lateral Cartilage Release on Patient‐Perceived Nasal Appearance and Obstruction
Weitzman, R. E., Gadkaree, S. K., Justicz, N. S., et al. (2021) · The Laryngoscope · doi:10.1002/lary.29872 · Cited by 3
“The traditional approach to SRP with spreader graft placement involves release of the upper lateral cartilages from the dorsum of the septum.(8) Our group has previously reported on the functional and aesthetic outcomes of the placement of spreader grafts with the release, and demonstrated improvement in nasal obstruc…”
Method
The Impact of Component Dorsal Hump Reduction on Patient‐Perceived Nasal Aesthetics and Obstruction in Rhinoplasty
Burks, C. A., Weitzman, R. E., & Lindsay, R. W. (2022) · The Laryngoscope · doi:10.1002/lary.30054 · Cited by 3
Grafting for nasal valve collapse
Miller, P. J., & Constantinides, M. S. (1999) · Operative Techniques in Otolaryngology-Head and Neck Surgery · doi:10.1016/s1043-1810(99)80063-3 · Cited by 3
Minds That Think Alike or Cryptomnesia?
Gruber, R. P. (2007) · Plastic & Reconstructive Surgery · doi:10.1097/01.prs.0000259188.34127.6e · Cited by 3
Spreader graft placement: Location, location, location
Seifman, M. A., & Greensmith, A. L. (2017) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2017.11.006 · Cited by 3
Internal Nasal Valve Expanding Graft for Middle Vault Reconstruction
Aladağ, İ., Songu, M., Aslan, H., İmre, A., & Pınar, E. (2019) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000005246 · Cited by 3
Spreader Graft Easy and Stable Fixation
Durán-Vega, H. C., & Regalado-Briz, A. (2019) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000002168 · Cited by 3
Anthropometric Evaluation of Photographic Images Before and After Functional Nasal Surgery in Patients With Deviated Noses
Lindemann, J., Stupp, F., Scheithauer, M., et al. (2020) · American Journal of Rhinology and Allergy · doi:10.1177/1945892420983116 · Cited by 3
Narrowing and Operated Appearance of the Middle Nasal Third after Hump Resection without Middle Vault Reconstruction
Tasman, A., & Gassner, H. G. (2021) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000007967 · Cited by 3
Stabilizing Cartilage Grafts in Functional-Aesthetic Rhinoplasty
Wagner, W., Riedel, F., & Bran, G. M. (2013) · Springer eBooks · doi:10.1007/978-3-642-28053-5_33 · Cited by 3
A Comparative Study of Isolated Osteotomies Versus Osteotomies with Spreader Graft Placement to Correct Primary Deviated Nose
Hernot, S., Agrawal, A., Kaintura, M., Maithani, T., & Dogra, R. (2021) · Aesthetic Plastic Surgery · doi:10.1007/s00266-021-02531-w · Cited by 3
Forty-five degree cutting septoplasty
Hsiao, Y.-C., Chang, C., Chuang, S., et al. (2016) · Plastic Surgery · doi:10.1177/229255031602400308 · Cited by 3
“One of the widely used methods for crooked nose treatment is the spreader graft with different modifications (2,20-22), which involves placement of a rectangular strip of cartilage on either side of the deviated septum.”
Method
Nasal Valve and Nasal Alar Dysfunction
Dolan, R. W. (2000) · Facial Plastic Surgery Clinics of North America · doi:10.1016/s1064-7406(23)00361-9 · Cited by 3
Basic Principles of Rhinoplasty
Koehler, J., & Waite, P. D. (2022) · Springer eBooks · doi:10.1007/978-3-030-91920-7_73 · Cited by 3
The Effects of Resorbable Plates on Rabbit Ear Cartilage
Mingrone, M. D., Porter, J. P., Lovice, D. B., et al. (1999) · Archives of Facial Plastic Surgery · doi:10.1001/archfaci.1.3.177 · Cited by 3
“When performing septorhinoplasty, deviated segments of septal cartilage can be straightened using bone or cartilage grafts acting as splinting grafts.(2-6) In some cases, cartilage or bone is not available without the additional surgical harvest of auricular or costal cartilage or calvarial/ iliac crest bone.”
BackgroundMethodInfluential
Structural rhinoplasty for the persistently twisted nose
Morisada, M. V., Humphrey, C. D., & Kriet, J. D. (2024) · Plastic and Aesthetic Research · doi:10.20517/2347-9264.2023.119 · Cited by 2
Internal Nasal Valve Collapse Treatment by Endonasal Hyaluronic Acid Injection
Gagnieur, P., Fieux, M., Saloner, L., et al. (2024) · Aesthetic Plastic Surgery · doi:10.1007/s00266-024-04186-9 · Cited by 2
“Treatment is mainly surgical (5, 15–18), through secondary rhinoplasty, but the operation is intricate and time-consuming (19).”
Closed Treatment of the Internal Nasal Valve
Boyce, C., Ovaitt, A. K., & Hetzler, L. T. (2025) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2024.08.012 · Cited by 2

Authors: Sheen, J. H.
Affiliations: University of California, Los Angeles (US)
Corresponding author: Sheen, Jack H.
Venue: Plastic and Reconstructive Surgery
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1984-02
Volume: 73
Issue: 2
Pages: 230-237
ISSN: 0032-1052 (ISSN-L)
DOI: 10.1097/00006534-198402000-00013
OpenAlex: W4312861572
Cited by: 614
References: 0
Citations by year: 2026: 15 · 2025: 32 · 2024: 23 · 2023: 14 · 2022: 37 · 2021: 38 · 2020: 35 · 2019: 28 · 2018: 22 · 2017: 20 · 2016: 28 · 2015: 29 · 2014: 27 · 2013: 33 · 2012: 15
FWCI: 1.14
Type: journal article
Language: en
Open access: closed
Locations: Plastic & Reconstructive Surgery (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Breast Implant and Reconstruction
Health Sciences › Medicine › Surgery › Reconstructive Surgery and Microvascular Techniques
Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
Keywords: spreader grafts, forehead reconstruction, scalp reconstruction, scalp flaps

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Spreader Graft: A Method of Reconstructing the Roof of the Middle Nasal Vault Following Rhinoplasty

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