Surgical Access to the Internal Nasal Valve

Abstract

Objectives: To measure the width of the nasal septum in the region of the internal nasal valve using radiographic images to support use of open septorhinoplasty for alteration of the internal nasal valve and to compare short-term patient satisfaction for open septorhinoplasty vs endonasal septoplasty. Study Design: Radiographic study and chart review. Methods: The width of the nasal septum at the level of the inferior turbinates and at the level of maximum septal thickness was measured on computed tomographic scans of 70 patients. Patient satisfaction 12 weeks after treatment was assessed in 113 patients who underwent septoplasty or open septorhinoplasty for nasal obstruction and septal and internal nasal valve abnormalities. Results: Measures from the computed tomographic scans revealed that the nasal septum was significantly wider at the internal nasal valve than at the inferior aspect of the septum. All 34 patients who underwent septoplasty and all 79 patients who underwent open septorhinoplasty were satisfied with the results at 12 weeks after surgery. Conclusions: Anatomic evidence supports the need to address the superior septum. Although this may be facilitated by an open septorhinoplasty approach, shortterm results showed no difference in patient satisfaction with this technique compared with septoplasty. The differences between the techniques may be evident on longterm follow-up.

The effect of allergic rhinitis on nasal septal body size

“…The NSB is known as the thickest part of the nasal septum and it is closely related to internal nasal valve region. [1] In a previous study, it has been reported as the mucosal thickness of the nasal septum. [2] In endoscopic examination, NSB appears as a prominence along the anterior and the middle part of the nasal septum.…”

“…It has been confirmed in several studies. [1,5,[8][9][10] But NSB compared with the inferior turbinate contains lesser amount of expansile tissue and thus its vasoactive capacity is not as much as the inferior turbinate. [11] However, even minimal changes in NSB can have a considerable impact on nasal resistance.…”

Triple-procedure technique in internal nasal valve surgery

“…Multiple surgical techniques are available to address the incompetent nasal valve: spreader grafts, alar batten grafts, crural strut grafts, suturing techniques including flaring sutures to the upper lateral cartilages, suspension sutures of the lateral crus to a bony base, thinning of the swollen [2,[10][11][12][13][14]. The aim of these surgical treatments is not simply to widen the airway but also to preserve the anatomy as much as possible and to preserve the laminar and parabolic airflow through the nasal valve area.…”

A New Surgical Technique of Internal Nasal Valve Collapse

“…The pa ti ent's no se sho uld be ob ser ved for col lap se on nor mal ins pi ra ti on. 3,4 The re are a num ber of sur gi cal ap pro ac hes ava i lab le to tre at na sal val ve col lap se. Se lec ti on of the ap prop ri a te sur gi cal in ter ven ti on de pends on pro per iden ti fi ca ti on of the ana to mic ca u se of the col lap se.…”

“…No ne of the se met hods is fre e of ad ver se si de-ef fects such as pa in, ble e ding, bo ne nec ro sis. 3,4 Simp son and Gro ves 5 first syste ma ti zed sub mu co sal di at hermy of the in fe ri or tur bi na tes with the aim of ob ta i ning ade qu a te tur bi na te re duc ti on with preser va ti on of the overl ying mu co sa in or der to avoid pos to pe ra ti ve at rop hic chan ges. The new bi po lar ra di o-fre qu ency in du ced ther mot he rapy, RFITT, has pro vi ded a gent ler and mi ni mal in va si ve the rapy for tur bi na te hyper trophy.…”