Spreader flap correction of dorsal septal deviations.

A good rhinoplasty dissection is crucial to identify and release the vectoral forces on a deviated septum before correction. Even after completing the dissection, dorsal hump reduction, septoplasty, and osteotomy, there may be persisting septal deviation. A number of techniques have been identified to correct various kinds of deviations that persist after release. Cartilage grafts from the septum itself, or from other regions (concha or ribs), or alloplastic materials are used to correct the dorsum. The spreader flap technique (so-called autospreader, turnover flap, or fold-in flap) may also be used for this purpose. In this technique, the upper lateral cartilage is separated from the septum and folded medially and dorsally following meticulous dissection of the mucoperichondrial flaps. Longitudinal scoring of the dorsal side may be performed if needed. In this way, problems such as dysfunction of the internal nasal valve, asymmetry of the nasal sidewall, and inverted-V deformity can be solved in a more autologous fashion. However, correction of dorsal deviations with caudal displacement, as an additional task, may also be achieved using spreader flaps.