Nasal Valve Surgery: How I do it?

Abdul Rahman Al Ghareeb, Jitendra Nagarbhai Patel, Mostafa Bakry

Ear, Nose & Throat Sleep Well Clinic, Noor Specialist Hospital, Manama, Bahrain.

DOI: 10.4236/ijohns.2013.21001                

Abstract

One of the reasons for patients attending ENT clinic with a persistent feeling of Nasal obstruction is the presence of a narrow nasal valve. Currently, there are many surgical methods for widening narrow nasal valves. Yet, most of these methods are difficult to perform and with unpredictable results. The main purpose of this study is to describe and evalu- ate our technique of minimally invasive nasal valve surgery. Thirty three patients, who attended our clinic complaining from of nasal obstruction, were evaluated for indication for nasal valve surgery, complications, and postoperative re- sults. Thirty one out of the 33 patients (94%) who underwent the surgery reported subjective improvement. Visual ana- logue score (VAS score) was used to estimate the degree of pre and postoperative nasal obstruction, the mean preopera- tive score was 8.891 and the mean postoperative was 3.241 and the improvement was statistically significant (P < 0.002), (R = 3.174). In conclusion, it can be said that the technique of Minimal Invasive Nasal Valve Surgery was found to be safe and extremely effective for most patients having narrow nasal valve.

Keywords

Nasal Obstruction; Nasal Valve Narrowing; Nasal Valve Surgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Marc Boris Bloching, “Disorders of the Nasal Valve Area,” Otolaryngology: Head and Neck Surgery, Vol. 6, 2007, p. Doc07.
[2]	M. Khosh, J. Albert, H. Carlo and P. Steven, “Nasal Valve Reconstruction,” Archives of Facial Plastic Surgery, Vol. 6, No. 3, 2004, pp. 167-171. doi:10.1001/archfaci.6.3.167
[3]	D. B. Wexler and T. M. Davidson, “The Nasal Valve: A Review of the Anatomy, Imaging, and Physiology,” The American Journal of Rhinology, Vol. 18, No. 3, 2004, pp. 143-150.
[4]	T. Bruintjes, A. Olphen, B. Hillen and E. A. Huizing, “Functional Anatomic Study of the Relationship of the Nasal Cartilages and Muscles to the Nasal Valve Area,” Laryngoscope, Vol. 108, No. 7, 1998, pp. 1025-1032. doi:10.1097/00005537-199807000-00014
[5]	M. Vaiman, E. Eviatar and S. Segal, “Intranasal Electromyography in Evaluation of the Nasal Valve,” Rhinology, Vol. 41, No. 3, 2003, pp. 134-141.
[6]	M. Constantian, “Differing Characteristics in 100 Consecutive Secondary Rhinoplasty Patients Following Closed versus Open Surgical Approaches,” Plastic and Reconstructive Surgery, Vol. 109, No. 6, 2002, pp. 2097-2111. doi:10.1097/00006534-200205000-00048
[7]	E. Ricci, F. Palonta, G. Preti, N. Vione, G. Nazionale, R. Albera, A. Staffieri, G. Cortesina and A. L. Cavalot, “Role of Nasal Valve in the Surgically Corrected Nasal Respiratory Obstruction: Evaluation through Rhinomanometry,” American Journal of Rhinology, Vol. 15, No. 5, 2001, pp. 307-310.
[8]	R. Gruber, A. Lin and T. Richard, “Nasal Strips for Evaluating and Classifying Valvular Nasal Obstruction,” Aesthetic Plastic Surgery, Vol. 35, No. 2, 2011, pp. 211-215. doi:10.1007/s00266-010-9589-4
[9]	T. Keck, R. Leiacker, S. Kühnemann, J. Lindemann, A. Rozsasi and N. Wantia, “Video-Endoscopy and Digital Image Analysis of the Nasal Valve Area,” European Archives of Oto-Rhino-Laryngology, Vol. 263, No. 7, 2006, pp. 675-679. doi:10.1007/s00405-006-0025-y
[10]	O. Hillberg, A. C. Jackson, D. L. Swift and O. F. Pederson, “Acoustic Rhinometry: Evaluation of Nasal Cavity Geometry by Acoustic Reflections,” Journal of Applied Physiology, Vol. 66, No. 1, 1989, pp. 295-303.
[11]	B. K. Howard and R. J. Rohrich, “Understanding the Nasal Airway: Principles and Practice,” Plastic and Reconstructive Surgery, Vol. 109, No. 3, 2002, pp. 1128-1144. doi:10.1097/00006534-200203000-00054
[12]	F. Noltenius, “Ein Einfaches Verfahren zur Symptomatischen Linderung der Ozaenabeschwerden,” European Archives of Oto-Rhino-Laryngology, Vol. 130, No. 4, 1932, p. 358. doi:10.1007/BF01591456
[13]	T. C. Amis, J. P. Kirkness, E. Di Somma and J. R. Wheatley, “Nasal Vestibule Wall Elasticity: Interactions with a Nasal Dilator Strip,” Journal of Applied Physiology, Vol. 86, No. 5, 1999, pp. 1638-1643.
[14]	B. Guyuron, B. Michelow and C. Englebardt, “Upper Lat Eral Splay Graft,” Plastic and Reconstructive Surgery, Vol. 102, No. 6, 1998, pp. 2169-2177. doi:10.1097/00006534-199811000-00058
[15]	R. F. André, S. H. Paun, H. D. Vuyk, “Endonasal Spreader Graft Placement as Treatment for Internal Nasal Valve Insufficiency: No Need to Divide the Upper Lateral Cartilages from the Septum,” Archives of Facial Plastic Surgery, Vol. 6, No. 1, 2004, pp. 36-40. doi:10.1001/archfaci.6.1.36
[16]	T. Akcam, O. Friedman and T. A. Cook, “The Effect on Snoring of Structural Nasal Valve Dilatation with a Butterfly Graft,” Archives of Otolaryngology—Head & Neck Surgery, Vol. 130, No. 11, 2004, pp. 1313-1318. doi:10.1001/archotol.130.11.1313
[17]	S. S. Rizvi and M. G. Gauthier, “How I Do It: Lateralizing the Collapsed Nasal Valve,” Laryngoscope, Vol. 113, No. 11, 2003, pp. 2052-2054. doi:10.1097/00005537-200311000-00037
[18]	R. C. Paniello, “Nasal Valve Suspension,” Archives of Otolaryngology, Head and Neck Surgery, Vol. 122, No. 12, 1996, pp. 1342-1346. doi:10.1001/archotol.1996.01890240050011
[19]	D. Lee and A. Galasgold, “Correction of Nasal Valve Stenosis with Lateral Suture Suspension,” Archives of Facial Plastic Surgery, Vol. 3, No. 4, 2001, pp. 237-240. doi:10.1001/archfaci.3.4.237
[20]	S. S. Park, “The Flaring Suture to Augment the Repair of the Dysfunctional Nasal Valve,” Plastic and Reconstructive Surgery, Vol. 101, No. 4, 1998, pp. 1120-1122. doi:10.1097/00006534-199804040-00036
[21]	J. Dutton and M. Neidich, “Intranasal Z-Plasty for Internal Nasal Valve Collapse,” Archives of Facial Plastic Surgery, Vol. 10, No. 3, 2008, pp. 164-168. doi:10.1001/archfaci.10.3.164
[22]	J. M. Clark and T. A. Cook, “The “Butterfly” Graft in Functional Secondary Rhinoplasty,” Laryngoscope, Vol. 112, No. 11, 2002, pp. 1917-1925. doi:10.1097/00005537-200211000-00002
[23]	D. L. Schulte, D. A. Sherris and E. B. Kern, “M-Plasty Correction of Nasal Valve Obstruction,” Facial Plastic Surgery Clinics of North America, Vol. 7, No. 3, 1999, pp. 405-409.
[24]	R. André and D. Vuyk, “Nasal Valve Surgery; Our Experience with the Valve Suspension Technique,” Rhinology, Vol. 46, No. 1, 2008, pp. 66-69.
[25]	D. M. Toriumi, J. Josen, M. Weinberger and M. E. Tardy, “Use of Alar Batten Grafts for Correction of Nasal Valve Collapse,” Archives of Otolaryngology—Head & Neck Surgery, Vol. 123, No. 8, 1997, pp. 802-808. doi:10.1001/archotol.1997.01900080034002