Cited by 619Breast Implant and ReconstructionReconstructive Surgery and Microvascular TechniquesReconstructive Facial Surgery Techniques

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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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Aesthetic and Functional Outcomes of Combined Use of Extended Spreader Graft and Septal Extension Graft
Jeon, Y. J., Lee, T.-H., Joo, Y.-H., & Kim, S. (2025) · Life · doi:10.3390/life15040546 · Cited by 2
Lateral Crural Mid-Down Flap Technique in Primary Rhinoplasty
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“The open roof deformity was reconstructed with spreader ﬂaps [19] or ULC fold-in ﬂaps [20].”
Mukosa-Dreiecksknorpellappen nach Walter erweitert die innere Nasenklappe
Maassen, M. M., & Walter, C. (2014) · Journal für Ästhetische Chirurgie · doi:10.1007/s12631-014-0321-0 · Cited by 2
Tiers moyen du nez et valve interne. Paroi alaire et valve externe
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The Aesthetic and Functional Roles of Spreader Flap in Primary Rhinoplasty
Elnaggar, A., & Ashraf, M. (2020) · The American Journal of Cosmetic Surgery · doi:10.1177/0748806820904298 · Cited by 2
“Component dorsal hump reduction was performed using 5 fundamental steps: (1) separation of the ULC from the septum; (2) reduction of the septum proper; (3) dorsal bony reduction (using an osteotome); (4) palpation of the dorsum; and (5) final modifications, if indicated (spreader graft, spreader flap, osteotomies).”
Method
Comparison of the Effect of Spreader and T-Splay Graft in Internal Nasal Valve Management
Kapı, E., Kopal, C., Seyhan, T., & Çelik, Y. (2022) · Aesthetic Plastic Surgery · doi:10.1007/s00266-022-02822-w · Cited by 2
Managing the Midvault - Autospreaders, Spreader Grafts or What?
Fedok, F. G., Robotti, E., & Marcus, B. C. (2024) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2024.06.013 · Cited by 2
Evaluation and Management of Lateral Wall Insufficiency.
Meyer, M. K. R., & Most, S. P. (2024) · Otolaryngologic clinics of North America · doi:10.1016/j.otc.2024.07.027 · Cited by 3
Comparison Of Surgical Techniques Used In Post-Traumatic And Non-Traumatic Rhinoseptoplasty
Rot, P., Krzywdzińska, S., Nicer, J., et al. (2024) · Otolaryngologia Polska · doi:10.5604/01.3001.0054.7427 · Cited by 2
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Barrera, J. E. (2025) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2024.10.004 · Cited by 2
The Cottle Method and Modifications in Preservation Rhinoplasty
Friedman, O. A., & Ulloa, F. L. (2025) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2025.01.001 · Cited by 2
Comparison of soft tissue effects of different orthognathic surgical approaches in class III patients using photographic analysis
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Outcomes of primary structural open rhinoseptoplasty: a large-scale registry study
Pirindov, K., Bromba, M., Restel, J., Farsakis, A., Lebbe, I., Dietz, A., & Dacho, A. K. (2025) · European Journal of Plastic Surgery · doi:10.1007/s00238-025-02318-1 · Cited by 2
Management of Mid-Vault Asymmetry in Secondary Unilateral Cleft Lip-Nose Deformity
Park, J. S., Jeong, H. H., & Koh, K. S. (2020) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000006776 · Cited by 2
“The mid-vault region of the nose is defined by the attachment of the upper lateral cartilages (ULCs) to the nasal bones superiorly and to the cartilaginous septum medially.1 Lateral wall insufficiency or mid-vault collapse is defined as the collapse of the lateral nasal wall of the ULC because of negative forces gener…”
Background
Management of the Middle Third in Revision Rhinoplasty
Liang, J. Z., Kim, J., & Sykes, J. M. (2013) · Springer eBooks · doi:10.1007/978-3-642-28053-5_76 · Cited by 2
El colgajo en “J” de la crus lateral del cartílago alar en el tratamiento del colapso de la válvula nasal
Franco‐Gutiérrez, V., Tapia, J. P. R., Tapia, J. P. R., & Albalad, M. P. C. (2006) · Acta Otorrinolaringológica Española · doi:10.1016/s0001-6519(06)78726-x · Cited by 2
RETRACTED ARTICLE: Evaluation of functional rhinoplasty using the Modified Cottle test in Asian patients
Kwun, C., Yang, C. W., Kim, S. W., et al. (2015) · Acta Oto-Laryngologica · doi:10.3109/00016489.2015.1108523 · Cited by 2
Retracted
Spreader Graft Injection with Calcium Hydroxylapatite
Nyte, C. P. (2013) · Springer eBooks · doi:10.1007/978-3-642-28053-5_53 · Cited by 2
An Easy Spreader Graft Fixation Technique by Using a Modified Speculum in Rhinoplasty
Başaran, K., Başat, S. O., & Saydam, F. A. (2015) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000001799 · Cited by 2
Cosmetic Surgery in the Elderly Patient
Friedman, O., Wang, T., & Cook, T. A. (2006) · CRC Press eBooks · doi:10.3109/9780849374487-53 · Cited by 2
Middle nasal valve collapse: a way to resolve
Milicic, D., & Serodio, C. (2018) · Journal of Otolaryngology-ENT Research · doi:10.15406/joentr.2018.10.00329 · Cited by 2
Cartilaginous Dorsum Repositioning Technique
Azimov, G. (2021) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000003151 · Cited by 2
Management of the Internal Nasal Valve
Shia, N. L., & Stephen, L. (2013) · Otorhinolaryngology Clinics - An International Journal · doi:10.5005/aijoc-5-1-21 · Cited by 2
The results of a comparative randomized study of the effectiveness of various methods for the correction of the nasal valve: the objective evaluation
Sobolev, V. P., Rusetsky, Y. Y., & Karapetyan, L. S. (2015) · Russian Bulletin of Otorhinolaryngology · doi:10.17116/otorino201580222-26 · Cited by 2
“Sheen [11] без дополнительных технических приемов или в комбинации с элементами эстетической ринопластики (рис.”
Dorsal Augmentation With the Dorsal Extension Spreader Graft
Phillips, S. J., Carney, M. J., Jazayeri, H. E., et al. (2022) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000008924 · Cited by 2
Cortical and Partially Cancellous Bone Spreader Grafts: An Alternative for the Treatment of Cartilage-Depleted Noses
Prado, A. S., Andrades, P. R., Guerra, C., & Wisnia, P. (2008) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0b013e3181708110 · Cited by 2
Tratamiento quirúrgico de la disfunción de la válvula nasal mediante la transposición del cartílago triangular
Armengot, M., Pérez, A., Izquierdo, J., et al. (2001) · Acta Otorrinolaringológica Española · doi:10.1016/s0001-6519(01)78223-4 · Cited by 2
The results of a comparative randomized study on the effectiveness of various methods for the correction of the nasal valve: the subjective evaluation
Sobolev, V. P., Rusetsky, Y. Y., & Karapetyan, L. S. (2015) · Russian Bulletin of Otorhinolaryngology · doi:10.17116/otorino201580152-55 · Cited by 2
Mathematical Analysis of the Functions of Spreader Graft
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Update on the Evaluation and Management of Nasal Valve Collapse
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The tile graft: A method of building the roof of the nose using preserved homograft septal cartilage
Planas, J. (1987) · European Journal of Plastic Surgery · doi:10.1007/bf00452768 · Cited by 2
“Sheen [ 19 ] has recently described an ingenious procedure of placing a strip of cartilage between perichondrium and septum to avoid the lateral depression in the region of the upper lateral cartilages.”
Background
Commentary on: Rhinoplasty: Surface Aesthetics and Surgical Techniques
Toriumi, D. M. (2013) · Aesthetic Surgery Journal · doi:10.1177/1090820x13478970 · Cited by 2
“Aesthetic Surgery Journal 33(3) 376 –377 © 2013 The American Society for Aesthetic Plastic Surgery, Inc.”
Background
Grafts Frequently Used During Orthognathic Surgery and for Adjunctive Procedures
Posnick, J. C. (2013) · Elsevier eBooks · doi:10.1016/b978-1-4557-2698-1.00018-6 · Cited by 1
The T‐graft to control nasal length and nasal tip position
Menger, D. J. (2021) · Clinical Otolaryngology · doi:10.1111/coa.13787 · Cited by 1
“The patient had a cartilaginous pollybeak deformation (1), under projection of the nasal tip (2) and an excess amount of columellar show (3).”
Background
Management of the Middle Vault
Pruthi, A., Dobratz, E. J., & Dougherty, W. (2023) · Facial Plastic Surgery · doi:10.1055/a-2148-2141 · Cited by 2
“17 ACottle elevator can be used to dissect a tight tunnel between the upper lateral cartilage and septum, with care taken to not disrupt the keystone area.”
Method
The Role of Spreader Grafts in Reduction Septorhinoplasty: A Randomized Clinical Trial With Quality of Life Assessment
Migliavacca, R., Lavinsky, M., Friedrich, E. P., Toledo, S. A. D. F., de Azeredo, A. M., & Silva, D. R. (2025) · The Laryngoscope · doi:10.1002/lary.32131 · Cited by 2
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Supraseptal groove fold-in flap for the reconstruction of middle vault in primary rhinoplasty
Karabağlı, Y., Ekinci, C., Karabağlı, S., & Özşahin, G. (2025) · JPRAS Open · doi:10.1016/j.jpra.2025.06.005 · Cited by 1
“6 8 Preservation rhinoplasty is a popular term; and its importance and implication are becoming more accepted day by day.”
Secondary Rhinoplasty: Clinical Findings and Alternative Structures for Nasal Reconstruction in Latin American Patients
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Cochran, C. S., & Gunter, J. P. (2011) · Elsevier eBooks · doi:10.1016/b978-1-4160-6262-2.00007-3 · Cited by 1
Osteotomies in Secondary Rhinoplasty
Gubisch, W. (2017) · Springer eBooks · doi:10.1007/978-3-319-67537-4_10 · Cited by 1
Secondary Correction of the Dorsum Including Polly-Beak Deformity
Gubisch, W. (2017) · Springer eBooks · doi:10.1007/978-3-319-67537-4_6 · Cited by 1
Reconstruction of Saddle Nose Deformity
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The Nasal Septum and Turbinates
Sulaiti, M. A., Duhirat, E. A., Saey, H. A., et al. (2020) · Springer eBooks · doi:10.1007/978-3-030-54088-3_32 · Cited by 1
Invited Discussion on: Surgical Management of the Internal Nasal Valve—A Review of Surgical Approaches
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“To prevent the problem of lateral nasal wall weakness, many researchers show more interest in the use of spreader flaps which were introduced by sheen in 1984 [3] and popularized by others: Gruber [4] and Byrd [5].”
Background
Technical Modification of the Conchal Cartilage Butterfly Graft to Enhance the Surgical Outcome for Dysfunctional Upper Lateral Cartilage
Kim, A. R., Choi, I. S., Jun, B. H., et al. (2010) · Journal of Clinical Otolaryngology Head and Neck Surgery · doi:10.35420/jcohns.2010.21.2.257 · Cited by 1
Dorsal Hump Reduction and Midvault Reconstruction
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Sekundäre Rhinoplastik
Mazzola, R. F. (2016) · Springer eBooks · doi:10.1007/978-3-662-48849-2_13 · Cited by 1
Nasal Obstruction and Sleep-Disordered Breathing
Scott, W. C., & Kent, D. T. (2021) · Springer eBooks · doi:10.1007/978-3-030-54146-0_16 · Cited by 1
Rhinoplasty in the Aging Patient
Greene, R. M., & Toriumi, D. M. (2007) · Elsevier eBooks · doi:10.1016/b978-1-4160-0146-1.50024-9 · Cited by 1
Secondary Septoplasty
Gubisch, W. (2017) · Springer eBooks · doi:10.1007/978-3-319-67537-4_2 · Cited by 1
Dorsocaudal reconstruction of previous caudal septal resections with partial split spreader graft
Ekinci, C., Can, B., & Koçman, A. (2022) · Journal of Surgery and Medicine · doi:10.28982/josam.1115725 · Cited by 1
“Spreader grafts are commonly used for this purpose [9].”
Background
SEPTORİNOPLASTİ YAPILAN HASTALARDA SPREADER GREFT KONULMASININ AMELİYATIN FONKSİYONEL VE ESTETİK SONUÇLARI ÜZERİNE ETKİSİ
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Updates in Butterfly Graft Technique
Miller, J. R., & Clark, J. M. (2023) · Facial Plastic Surgery · doi:10.1055/s-0043-1774332 · Cited by 1
Aesthetic and reconstructive dorsal augmentation
Zholtikov, V., Ouerghi, R., & Daniel, R. K. (2023) · Plastic Surgery and Aesthetic Medicine · doi:10.17116/plast.hirurgia20230315 · Cited by 1
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Swamy, V., Phelan, A. L., Abdelrahman, A., et al. (2023) · Aesthetic Plastic Surgery · doi:10.1007/s00266-023-03778-1 · Cited by 1
Apaydin Classification of Spreader Flaps Updated
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“1 – 6 One such technique is the use of spreader grafts, which was ﬁ rst described by Sheen in 1984.”
Proximal Intact Spreader Graft in Let-Down Dorsal Preservation Rhinoplasty
Öztürk, G. (2024) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000004152 · Cited by 1
The Nasal Valves
Elwany, S. (2024) · Springer eBooks · doi:10.1007/978-3-031-70077-4_11 · Cited by 1
Spare Roof Technique A and B – A Step-by-step Guide to Avoid Suboptimal Outcomes
Ferreira, M. G., Shaker, M., & Santos, M. (2025) · Facial Plastic Surgery Clinics of North America · doi:10.1016/j.fsc.2025.01.005 · Cited by 1
The Nasal Valves
Friedman, O. (2013) · Springer eBooks · doi:10.1007/978-3-642-37250-6_22 · Cited by 1
Intermediate Osteotomy and other Unique Techniques used in Reduction Rhinoplasty
Devasamudra, C. R., & Devasamudra, C. R. (2016) · Clinical Rhinology An International Journal · doi:10.5005/jp-journals-10013-1254 · Cited by 1
Management of the Crooked Nose
Scordino, J. W., & Stucker, F. J. (2016) · International Journal of Head and Neck Surgery · doi:10.5005/jp-journals-10001-1283 · Cited by 1
Morphological Change after Septoplasty for Septal Deviation with External Nose Deformity
Iimura, J., Nakagami, K., Tsumiyama, S., et al. (2017) · Nihon Bika Gakkai Kaishi (Japanese Journal of Rhinology) · doi:10.7248/jjrhi.56.160 · Cited by 1
Concurrent Rhinoplasty and Endoscopic Sinus Surgery
Gendeh, B. S. (2019) · IntechOpen eBooks · doi:10.5772/intechopen.89415 · Cited by 1
Basic Techniques for Endonasal Rhinoplasty
Güler, İ., Guvenc, I. A., & Soo, G. (2019) · Springer eBooks · doi:10.1007/978-3-030-21217-9_92 · Cited by 1
Management of the Deviated Septum
Karaoğullarından, A., González, J. R., Winkler, A. A., & Cingi, C. (2019) · Springer eBooks · doi:10.1007/978-3-030-21217-9_96 · Cited by 1
Trends in Functional Rhinoplasty
Weissman, J. D., & Most, S. P. (2013) · Springer eBooks · doi:10.1007/978-3-642-28053-5_12 · Cited by 1
Is There a Risk of Saddle Nose Deformity after Spreader Grafts and Flaps?
Eweiss, A. Z. (2022) · Facial Plastic Surgery · doi:10.1055/a-1760-1709 · Cited by 1
The functional and cosmetic aspects of alar batten graft
Hong, T. U., Oh, J., & Choi, J. Y. (2022) · The Journal of Cosmetic Medicine · doi:10.25056/jcm.2022.6.1.61 · Cited by 1
State of the Art in Secondary Cleft Rhinoplasty: Comprehensive Technical Details and Deformity-Specific Approach
Denadai, R., & Lo, L. (2022) · Springer eBooks · doi:10.1007/978-981-19-3163-5_22 · Cited by 1
Correcting Deviated Noses, Septoplasty and Turbinectomy
Guyuron, B. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4160-3751-4.00017-6 · Cited by 1
Correction of Hump Nose Considering the Characteristics of Korean Nose
Kim, J. S., & Yu, K.-K. (2014) · Korean Journal of Otorhinolaryngology - Head and Neck Surgery · doi:10.3342/kjorl-hns.2014.57.12.815 · Cited by 1
THE PLASTIC SYRINGE AS SOFT-TISSUE PROTECTOR DURING DRAINAGE TUBE INSERTION
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Discussion of the Article by Fayman and Potgieter
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“This is not to say that the spreader graft is not important, because it is one of the greatest additions to our armamentarium, thanks to the pioneering work of Sheen [13] and Constantian et al. [4,5].”
Background
Principles of rhinoplasty
Rao, N., & Toriumi, D. M. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-48410-7.00038-1 · Cited by 1
Nasal Osteotomy and Airway Changes
Toriumi, D. M. (1998) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-199809030-00038 · Cited by 1
Primary Open Rhinoplasty
Hussien, W. K. (2024) · Springer eBooks · doi:10.1007/978-3-031-70077-4_47 · Cited by 1
Adjunctive Surgical Therapies in the Treatment of Rhinosinusitis
Guss, J., & Thaler, E. R. (2008) · Springer eBooks · doi:10.1007/978-0-387-73062-2_16
“Surgical correction of internal valve collapse involves widening the angle between the caudal edge of the lower lateral cartilage and the nasal septum to increase the area of the airway; this is typically done by placing two strips of cartilage between the dorsal septum and the upper lateral cartilage, called spreader…”
Method
Physiologic Concerns During Rhinoplasty
Kern, E. B. (2013) · Springer eBooks · doi:10.1007/978-3-642-37250-6_36
Structural Grafts and Suture Techniques in Rhinoplasty
Müller-Vogt, U., & Gassner, H. G. (2013) · Springer eBooks · doi:10.1007/978-3-642-28053-5_38
In reference to Sonic Rhinoplasty</
Murrell, G. L. (2010) · The Laryngoscope · doi:10.1002/lary.21339
THE “LAPEL” TECHNIQUE
Seyhan, A. (1998) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-199811000-00076
The use of autogenous cartilage grafts in revision nasal surgery
Stucker, F. J., Nathan, C. O., & Lian, T. (2003) · International Congress Series · doi:10.1016/s0531-5131(03)00942-7
Railway graft for internal nasal valve reconstruction
Cil, Y., & Koçman, A. (2014) · European journal of plastic surgery · doi:10.1007/s00238-014-0992-y
“[23], and butterfly graft [2, 20] correct the nasal valve by supporting upper laterals.”
BackgroundMethod
Tratamiento quirúrgico secundario de las hendiduras labioalveolopalatinas
Vanwijck, R., & Bayet, B. (2000) · EMC - Cirugía Plástica Reparadora y Estética · doi:10.1016/s1634-2143(00)72185-6
Les échecs de rhinoplastie : erreurs techniques ou méconnaissance de la dynamique du nez
Aiach, G. (2004) · Annales de Chirurgie Plastique Esthétique · doi:10.1016/j.anplas.2004.10.005
Management of the Crooked Nose Deformity
Young, P. A., & Stucker, F. J. (2009) · Springer eBooks · doi:10.1007/978-3-540-74380-4_72
Viability of Chondrocytes in the Crushed Septal Cartilage Depending on Degree of Crushing and Their Mechanism of Cell Death
Chung, Y., Moon, T.-H., Kim, I.-S., et al. (2009) · Korean Journal of Otorhinolaryngology - Head and Neck Surgery · doi:10.3342/kjorl-hns.2009.52.2.149
An overview of seeding methods to restore tropical forests of Brazil
Engel, V. L., de Souza, D. C., & Parrotta, J. A. (2014) · REFORESTA · doi:10.21750/refor.21.07.137
Septal Surgery in the Crooked Nose
Foda, H. M. T. (2013) · Springer eBooks · doi:10.1007/978-3-642-28053-5_43
Nasal Valve Surgery
Goode, R. L. (2009) · Springer eBooks · doi:10.1007/978-3-540-74380-4_73
Use of the Spring Graft for Prevention of Midvault Complications in Rhinoplasty
McKinney, P. W. (2008) · Yearbook of Plastic and Aesthetic Surgery · doi:10.1016/s1535-1513(08)70604-0
Rhinoplasty in the Aging Patient
Chung, V., Rao, N., & Toriumi, D. M. (2018) · Elsevier eBooks · doi:10.1016/b978-0-323-35876-7.00026-1
Evaluation and Correction of the Crooked Nose
Brenner, M. J., & Hilger, P. A. (2011) · Elsevier eBooks · doi:10.1016/b978-1-4160-6262-2.00022-x
The Nasal Airway
Mobley, S. R., Orlandi, R. R., & Toriumi, D. M. (2006) · Elsevier eBooks · doi:10.1016/b978-0-7216-0000-0.50044-x

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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