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AUTOSPREADER FLAPS IN PRIMARY RHINOPLASTY – SAVING TIME, SEPTUM RESOURCES AND DORSUM WIDTH IN SELECTED CASES.


Argentina Vidrascu

Objectives
Spreader grafts technique could have some disadvantages in primary rhinoplasty. First of all is the expanding operating time due the septal harvesting. Second, the postoperative septal swelling is considerable after septum dissection and cartilage harvesting. Sometimes, the external mildvault width is much more wider after spreader grafts are applied. Comparing to that autospreader flaps method ( Ayhan, 2008) in dorsum management it is an up to date technique – preserves the septum, reduces the surgical time in order to maintain or restore dorsal aesthetic lines and internal valve function.

Working method
In selected 50 primary rhinoplasty cases with a high narrow dorsum patients, it is no need to harvest septum cartilage for superior alar cartilage alignment in order to prevent the inverted V deformity and internal valve collapse.
After the Superior Alar Cartilages (SAC), dorsal septum dissection and tangential excision the excessive SAC segment, which is usually resected, is preserved. Folding the superior alar cartilages in to and against the edge of the septum at the median line level so that the auto graft is bilaterally interposed between the septum and SAC. Flaps rotation is performing with an anatomical forceps, fixation – by two 5-0 PDS mattress sutures. The SAC excess is being appreciate just after the septum and bony hump reduction was done.

In two cases additional unilateral spreader graft was required to correct asymmetric dorsal aesthetic lines.

Results
The follow up demonstrates better postoperative recovery with much less septal swelling comparing to spreader grafts harvesting technique. Continuous and parallel dorsal aesthetic lines with no mildvault over widening. Satisfactory aesthetic results where achieved in 49 cases . One case - left SAC retraction.

Conclusions
In primary rhinoplasty autospreader technic it really works as a precise way for hump reduction preserving dorsal aesthetic lines and internal valve function with a proportional dorsum width outcome.


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