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Original Investigation
March 21, 2019

Analysis of Patient-Perceived Nasal Appearance Evaluations Following Functional Septorhinoplasty With Spreader Graft Placement

Author Affiliations
  • 1Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
  • 2Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
  • 3Department of Otolaryngology, University of Minnesota, Minneapolis
JAMA Facial Plast Surg. 2019;21(4):305-311. doi:10.1001/jamafacial.2018.2118
Key Points

Question  Is spreader graft placement for the treatment of nasal valve dysfunction associated with improved patient-perceived nasal appearance?

Findings  This cohort study of 154 patients undergoing functional septorhinoplasty with spreader graft placement found that NOSE (Nasal Obstruction Symptom Evaluation), FACE-Q Satisfaction With Nose, and FACE-Q Satisfaction With Nostrils scores were improved significantly after surgery.

Meaning  Despite concerns that spreader grafts have a negative aesthetic effect, the significant postoperative cosmetic improvements reported by the patients in this study after spreader graft septorhinoplasty suggest that this might be a viable technique for treatment of nasal valve dysfunction.


Importance  Spreader grafts have been shown to improve nasal airway obstruction in patients with nasal valve dysfunction; however, their use has been limited by concerns over their aesthetic penalty of widening the nasal dorsum.

Objective  To evaluate the association of functional septorhinoplasty (FSRP) using spreader graft placement with patient satisfaction with nasal appearance postoperatively.

Design, Setting, and Participants  This prospective cohort study was conducted in a university-based tertiary care medical center. All participants were patients undergoing FSRP for the treatment of nasal obstruction who had spreader grafts placed between June 2016 and May 2018.

Exposures  The Nasal Obstruction Symptom Evaluation (NOSE) scale and the FACE-Q Satisfaction With Nose, FACE-Q Satisfaction With Nostrils, and FACE-Q Social Functioning scales were administered to patients preoperatively and at 2, 4, 6, and 12 months postoperatively. Patient demographics, nasal history, and outcomes were analyzed.

Main Outcomes and Measures  Comparison of preoperative and postoperative NOSE and FACE-Q scores.

Results  A total of 154 patients (72 male [46.8%]) with mean (SD) age of 36.8 (15.4) years underwent FSRP with spreader graft placement. Mean (SD) last follow-up was 5.8 (4.1) months postoperatively (range, 2-12 months). Fifty-seven patients had 6 months follow-up, and 42 patients had at least 12 months of follow-up. At time of last follow-up, mean (SD) NOSE and FACE-Q Satisfaction With Nose, Satisfaction With Nostrils, and Social Functioning scores significantly improved from 62.7 (20.7) to 22.8 (21.0) (P < .001), 54.7 (22.2) to 76.2 (25.1) (P < .001), 59.4 (27.9) to 83.6 (24.8) (P < .001), and 73.6 (21.8) to 81.7 (21.9) (P < .001), respectively. When separated into those with only spreader grafts (n = 89) and those with spreader grafts plus other graft types (n = 65), there was no significant difference between score improvements in the 2 groups. There were no significant differences in final nasal appearance scores between patients undergoing functional vs dual functional and cosmetic FSRP.

Conclusions and Relevance  Despite concerns that placement of spreader grafts for the treatment of nasal obstruction due to nasal valve dysfunction during FSRP may have a negative impact on nasal aesthetics, this study shows that both nasal obstruction and patient satisfaction with their nasal appearance were significantly improved following surgery.

Level of Evidence  3.