Modified Spreader Flap Tension Suture Technique for Internal Nasal Valve Reconstruction: A 580-Patient Cohort Study

The internal nasal valve (INV) is a key determinant of nasal airflow and is dependent on middle vault integrity. While spreader grafts remain the gold standard for reconstruction, the spreader flap offers a tissue-preserving alternative.

This study evaluates outcomes of a modified spreader flap tension suture technique with composite flap elevation in 580 patients, with the hypothesis that this approach yields favorable functional improvements.

Retrospective cohort study.

Patients who underwent the described procedure were retrospectively identified. Inclusion required a dorsal hump reduction of >3 mm in all cases. Patients were stratified into three groups according to clinical presentation: those undergoing dorsal refinement alone, those with concurrent septal deviation or turbinate hypertrophy, and those with primary INV insufficiency. Prior dorsal rhinoplasty or significant septal deviation were exclusion criteria. Pre- and postoperative (6 months) peak nasal inspiratory flow (PNIF) measurements and visual analog scale (VAS) scores were compared to evaluate objective and subjective functional improvement, respectively.

The dorsal refinement group (n = 362) demonstrated stable functional outcomes, with a mean VAS improvement of 2 points. The septal deviation/turbinate hypertrophy group (n = 158) had a mean PNIF increase of 27 L/minute and a 3.5-point VAS improvement, while the INV insufficiency group (n = 60) showed greater gains (PNIF +35 L/minute; VAS +5 points).

The modified spreader flap is an effective, cartilage-preserving technique for INV reconstruction, yielding consistent functional and aesthetic outcomes. Further controlled studies are required to assess long-term results.