Costal Cartilage Lateral Crural Strut Graft vs Cephalic Crural Turn-in for Correction of External Valve Dysfunction

Abstract

IMPORTANCE External nasal valve dysfunction (EVD) is a common cause of nasal obstruction.OBJECTIVE To evaluate costal cartilage lateral crural strut grafts vs cephalic crural turn-in to support the weak lateral crus in patients with EVD. DESIGN, SETTING, AND PARTICIPANTSIn this prospective cohort study, patients with clinically diagnosed EVD were assessed at the Tertiary Rhinologic Center and underwent a costal cartilage underlay graft to the lateral crus or a cephalic turn-in cruralplasty. MAIN OUTCOMES AND MEASURES Assessment of patient benefit was based on 22-Item Sinonasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation Scale (NOSE) scores. A Likert scale was also used to assess overall function and cosmesis. Objective assessment included postdecongestion nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area. RESULTS Forty-one patients (mean [SD] 35.38 [12.73] years of age; 25 [61%] female) were assessed. Cephalic turn-in maneuver was used for 25 (61%) patients; costal cartilage lateral crural strut grafts, 16 (39%) patients. Costal cartilage grafts were used in patients undergoing revision but other baseline data were similar. Follow-up was mean 10.58 (7.52) months. All patients had significantly improved visual analog scale, SNOT-22, NOSE, patient-reported function, and cosmesis scores. The only objective test that improved was nasal peak inspiratory flow (114.76 [60.48] L/min vs 126.46 [61.17] L/min; P = .02). CONCLUSIONS AND RELEVANCE Both techniques were effective in improving patient-reported outcomes and nasal peak inspiratory flow. Both are functionally and cosmetically viable options for correction of EVD. LEVEL OF EVIDENCE 2.

Evaluating the Effect of Spreader Grafting on Nasal Obstruction Using the NOSE Scale

“…5-8 To date, over 20 studies have used the NOSE scale as a primary tool for making surgical outcomes comparisons in the treatment of nasal passage obstruction. 3,5-28 Many previous studies have had relatively small sample sizes, however, and have not directly evaluated the effect of spreader grafting.…”

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Position Paper on Nasal Obstruction: Evaluation and Treatment

“…Sometimes it occurs after rhinoplasty and septal or turbinate surgery [237]. The numerous techniques proposed to remedy this situation include grafting [238][239][240][241][242][243] (eg, spreader and batten grafts [244][245][246][247][248]), implants [249,250], and other procedures [251][252][253][254][255][256].…”