Evolution and Versatility of the Bilateral Extended Spreader Graft: A Review and an Update to the Tongue-and-Groove Technique.

[BACKGROUND] Initially introduced by the senior author (B.G.) for lengthening the short nose, bilateral extended spreader grafts (BESG) in the form of the tongue-and-groove (TAG) technique have gained additional indications in current septorhinoplasty practice. The purpose of this study is to discuss the evolution of this versatile technique with a literature review and retrospective review of the senior author's experience.

[METHODS] PubMed searches were conducted for "bilateral extended spreader graft" and "tongue-and-groove rhinoplasty". A retrospective chart review was performed for septorhinoplasty patients at the senior author's practice between 2015 and 2020.

[RESULTS] BESG have been used to realign the deviated nose and control nasal length. In addition to lengthening the short nose, the BESG technique can augment tip projection and align the caudal nose structures. A total of 397 septorhinoplasty patients were reviewed for this study. There were 258 (65.0%) cases of primary septorhinoplasties. The BESG technique was used in 31 (7.8%) patients for the nose elongation, all of whom underwent an open surgical approach. Bilateral spreader grafts (extended and non-extended) were used in 162 (40.8%) patients; among these patients, 135 (34.0%) had columellar struts placed concomitantly.

[CONCLUSION] In addition to nasal elongation, BESG can increase tip projection and better align the tip with the dorsum. The BESG technique continues to be highly consistent and dependable for correcting difficult nasal deformities.

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