Comparative Outcomes in Functional Rhinoplasty With Open vs Endonasal Spreader Graft Placement.

IMPORTANCE: Spreader grafts are commonly used for nasal valve stenosis. There is debate among practitioners regarding the optimal approach for spreader graft placement.

OBJECTIVE: This study aimed to determine whether an endonasal spreader graft placement leads to equivalent postoperative outcomes using a standardized nasal obstruction symptom score and whether there is a significant difference in operative time between the 2 approaches.

DESIGN: A retrospective review of functional rhinoplasties by a single facial plastic surgeon over a 2-year period was conducted.

SETTING: Facial plastic surgery practice at a tertiary academic medical center.

PARTICIPANTS: Fifty patients with a single surgeon over a 22-month period with a minimum of 1-year follow-up were included in the study. Age, sex, and preoperative Nasal Obstruction Symptom Evaluation (NOSE) scores of patients were equivalent between the 2 groups. For time analysis, 56 of 107 patients were analyzed, with exclusion of patients undergoing combined procedures and autologous cartilage grafting from sites besides the nasal septum.

INTERVENTIONS: Patients who underwent functional rhinoplasty through either an open or an endonasal (closed) approach were compared. Preoperative approach decision was based on the need for cosmetic tip, dorsal, or anterior septal work, and all decisions were made before the development of this study. Main outcome measures were as follows: improvement in NOSE scores recorded preoperatively and at 1-year minimum postoperative follow-up as well as difference in operative times.

RESULTS: No significant difference (P = 0.92) was found between patients having open or endonasal spreader graft placement in NOSE score improvement. Open rhinoplasty was associated with significantly longer operative times (P < 0.001), and performance of additional maneuvers such as strut grafts, osteotomies, and dorsal hump reduction was not found to independently affect operative times significantly.

CONCLUSIONS AND RELEVANCE: Spreader grafts can be placed through an endonasal or open approach with similar outcomes in a standardized measure. Open rhinoplasty is associated with prolonged operative times and therefore increased operative costs. In properly selected patients, endonasal spreader graft placement may lead to significant cost savings when open rhinoplasty is not otherwise indicated.