title: Spreader graft placement in endonasal rhinoplasty: Technique and a review of 100 cases.
abstract: BACKGROUND
  Spreader grafts are widely considered to be the mainstay of treatment for insufficient internal nasal valve and are commonly placed preventively during rhinoplasty, after hump removal, to avoid middle vault collapse. Although the placement and suturing of spreader grafts in open rhinoplasty is fairly easy, their positioning and stabilization in endonasal rhinoplasty is associated with a learning curve.
  
  
  METHODS
  A review of the technique with tips for the novice surgeon is presented, particularly as pertains to correct placement. The technique can be used to insert spreader grafts irrespective of whether the nasal dorsum is addressed. Suturing is usually unnecessary. A retrospective review of 100 patients in whom spreader grafts were placed was undertaken to evaluate complications such as poor placement, displacement or other complications.
  
  
  RESULTS
  Although there is a learning curve to ensure the dorsal mucosal attachment is maintained while developing the pocket sufficiently dorsally for proper graft placement, the technique is easy to learn, effective, quick and technically simple to perform. Of 100 patients, three had a cartilaginous dorsal spur as the cephalic edge of the graft became visible. One patient developed an ecchymosis along the dorsum that caused a hump that resolved in two months. There were no other aesthetic or functional complications.
  
  
  CONCLUSIONS
  The endonasal placement technique provides for simple, safe and easy placement, as well as stabilization of spreader grafts during endonasal rhinoplasty, with few complications.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec.
authors.forename: M
authors.initials: M
authors.lastname: Samaha
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec.
authors.forename: A
authors.initials: A
authors.lastname: Rassouli
keywords: Endonasal; Internal valve stenosis; Rhinoplasty; Spreader graft