Spreader grafts

See how spreader grafts can be used to improve internal nasal valve narrowing and treat chronic nasal congestion without needing a breathe right strip.

What is the internal nasal valve?

The internal nasal valve is narrowest part of the entire upper airway (from the nostrils all the way down to the trachea). It is located in the middle third of the nose where the upper lateral cartilages attach to the septum. The schematic below illustrates where these cartilages are situated:

Upper lateral cartilage and lower lateral cartilage anatomy schematic

This cross sectional schematic shows an even better view of how this valve forms where the upper lateral cartilage meets the septum:
Upper lateral cartilage and septum cross section schematic showing internal nasal valve

In some people the upper lateral cartilage is relatively weak and ends up becoming narrowed or pinched in this area. As a result, the airflow through the internal nasal valve inside the nose is restricted. This schematic shows how the upper lateral cartilages can become pinched:
Collapsed upper lateral cartilages schematic

 

Internally, the effect on the internal nasal valve can be seen in this schematic simulation of right internal nasal valve narrowing:

Collapsed right upper lateral cartilage schematic

How a spreader graft can widen a collapsed internal nasal valve

A spreader graft is a cartilage graft that is insert between the septum and upper lateral cartilage, thereby widening the area of narrowing and opening up the internal nasal valve. The cartilage is usually carved from septal cartilage that is removed during a concurrent septoplasty. You can see video showing how a spreader graft is carved here. The schematic cross section below shows how the spreader graft can widen the internal nasal valve:
Right spreader graft cross section schematic

 

You can also see how lateralizing the narrowed upper lateral cartilage can also create improved nasal symmetry.

Frontal schematic of spreader grafts


Examples of spreader graft placement

Spreader grafting placed to treat patient's left more than right middle third narrowing
Bilateral spreader graft placement combined with hump reduction and bulbous tip repair
Asymmetric spreader graft placement to treat middle third narrowing. Middle pane shows preop computer morphing
Spreader grafting to treat severely crooked nose