Surgical techniques for the treatment of nasal valve collapse: a systematic review

Abstract

Objectives. To critically evaluate the surgical treatment strategies for nasal valve collapse and their outcomes. Method. A systematic review of studies for surgically treated nasal valve collapse from 1970 to 2006 including an analysis of techniques and their outcomes. Database search of EBM reviews, (Cochrane, DARE, CCTR & ACP Journal club), Medline and EMBASE’ including a hand search of bibliographies in identified papers. The outcomes used are success of techniques at relieving symptoms and cosmesis. The inclusion criteria was a minimum of 10 patients in each study with a defined minimum 6‐month period of follow‐up. Results. No randomised trials exist; 31 studies met the minimal inclusion criteria. Seventeen addressed the internal nasal valve, seven the external nasal valve and seven both. A variety of techniques have been used including spreader grafts, alar batten grafts, splay grafts, butterfly grafts, and lateral expansion sutures. All techniques have high success rates with no single technique appearing more successful than others. Studies had similar inclusion criteria and a mean follow up >12 months. The level of evidence is III. Few studies provided objective measures of nasal airflow in the form of rhinomanometry, but when presented results were significantly improved. Conclusions. A variety of surgical techniques are available to deal with nasal valve collapse. The specific pathological problem causing obstruction at the nasal valve must be identified and the surgical solution tailored to the individual. There is no ‘one size fits all’ procedure.

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

“…However, these patients were deemed to have EVD as their primary cause of their nasal obstruction on clinical assessment by 2 experienced rhinoplasty surgeons in line with consensus statements, and the correction of septal abnormalities and turbinate reduction was applied consistently across both groups. Objective outcomes following surgical management of EVD have historically been lacking in the literature 3,20 and have actually been discouraged or dismissed due to poor correlation with subjective measures. 21 This is in contrast to patientreported outcomes, which have been deemed more important and correlate well with patient satisfaction.…”

Lateral Crural Setback With Cephalic Turn-in Flap

“…The structure and support of the alar cartilage may not seem compromised at first, but long-term stability as a result of contractile forces may cause weak cartilages to be at risk. 9,10 Herein, I describe the lateral crural setback in combination with a cephalic turn-in flap (LSCT) as a new technique for management of the drooping nose. I tried to preserve structural integrity of alar cartilage as much as possible in this technique.…”

Update on the evidence for functional rhinoplasty techniques

“…As a result, much of our knowledge in nasal valve surgery is based on retrospective reports. That being said, both Rhee et al [59] and Spielmann et al [10] found that despite the lack of level I data, there is good evidence that nasal valve surgery is beneficial for patients. In 2010, Rhee et al [6] proposed guidelines for treatment of nasal valve collapse based on available literature and expert consensus.…”

“…Clinicians use both the Cottle and modified Cottle maneuvers to diagnose NVC. [10] Attention should also be paid to hypertrophic turbinates, caudal septal deflections, and wide medial crural footplates.…”