A New Wedge-Shaped Spreader Graft for Correcting Curvature at the Osteocartilaginous (Key-Stone) Junction of the Nasal Septum

Author: Dr. Myung Ju Lee MD PhD, VIP Plastic Surgery Clinic

Objective

The nasal septum is composed of bone (ethmoid, vomer) in its upper portion and cartilage in its lower portion. When a septal deviation occurs at the osteocartilaginous junction (often referred to as the “key-stone area”), it cannot be corrected with conventional methods such as SMR (Submucosal Resection), the swing-door technique, or standard spreader grafts. Moreover, because the key-stone area plays a crucial role in maintaining the external nasal framework, separating the bone-cartilage junction poses significant risks. As a result, there has previously been no straightforward method to correct deformities in this region without detaching this junction. The author devised a new approach, a “wedge-spreader graft,” to correct key-stone area deviations safely—without separating the bony-cartilaginous connection—and aims to validate its effectiveness.

Materials and Methods

From January to February 2005, 18 patients who underwent rhinoplasty and were diagnosed with septal deviation at the key-stone area were selected. The author reviewed their medical charts, surgical records, and pre- and postoperative photographs.

Technique

1. Exposure and Preparation

   • After separating the upper lateral cartilages from the dorsal septum, a fine osteotome is used on the concave side to create a paramedian space of about 3–7 mm into the bone.

2. Graft Placement

   • A single spreader graft is inserted from the newly created bony space above the key-stone area down to the lower portion of the septal cartilage.
   • Instead of using conventional cartilage grafts, the author employs a bony septum graft (either ethmoid or vomer), which is then secured to the septum with 4–0 PDS sutures.

Results

Because the wedge-spreader graft extends above the key-stone area and involves rigid bony structures (like the bony septum), there were instances where additional fixation was necessary to ensure stability at the osteocartilaginous junction.

Conclusions

This wedge-shaped spreader graft technique corrects deviations at the key-stone area without detaching the bone-cartilage junction. By preserving the key-stone region’s integrity, it offers a safe and effective solution for septal deviations that extend into critical supporting structures of the nose. The author proposes that this method serves as a convenient and beneficial option for managing complex nasal deformities involving the key-stone area.