Balanced Cantilever Graft for Supporting the Cartilaginous Side Wall of Nose

2021 ◽  
Author(s):  
Ullas Raghavan ◽  
Mahmoud Daoud ◽  
Emily G Heywood ◽  
Gautham Ullas
Keyword(s):  
Objective Assessment ◽  
Side Wall ◽  
Inferior Turbinate ◽  
Lateral Wall ◽  
Septal Cartilage ◽  
Lateral Nasal Wall ◽  
Nasal Valve ◽  
Flow Through ◽  
Nasal Peak Inspiratory Flow

Abstract Background Many locations for the nasal valve have been suggested. Later came the concept of the flow limiting segment. Rather than an internal and external valve, flow through the nose is regulated by the cartilaginous side wall, septum and inferior turbinate. Objectives To assess the use of balanced cantilever graft (BCLG), a technique to support the lateral nasal wall. Methods Patients undergoing primary open septorhinoplasty over a 2-year period were studied. Follow up period was a minimum of 6 months to a maximum of 24 months. Subjective improvement of function was measured with VAS and aesthesis by FACE Q score. Objective assessment of airway was done by a Nasal Peak Inspiratory Flow (NPIF) meter. Strips of septal cartilage of sufficient dimensions were placed in submucosal pockets created under the area of the lateral wall to be supported. Results Sixty patients underwent BCLG. VAS for nasal obstruction increased from 2.6 pre-operatively to 8.1 post-operatively. FACE Q increased from 16.7 pre-operatively to 36.6 post-operatively. NPIF was 74.9 L/minute pre-operatively, improving to 95 L/min post-operatively. Statistically significant improvements were seen in functional and aesthetic scores. Conclusions Balanced cantilever grafts support the weakened part of lateral nasal wall by their elastance. Minimal cartilage is required and can be altered to support various parts of the lateral nasal wall. This graft does not cause an aesthetic deficiency whilst providing adequate support.

Septal Cartilage Graft for Nasal Valve Incompetence Associated with Deviated Septum

2007 ◽  
Vol 21 (5) ◽  
pp. 622-625 ◽  
Author(s):  
Paolo Paccoi ◽  
Valerio Di Peco
Keyword(s):  
Nasal Septum ◽  
Airflow Obstruction ◽  
Inferior Turbinate ◽  
Lateral Wall ◽  
Septal Cartilage ◽  
Cartilage Graft ◽  
Nasal Airflow ◽  
Nasal Valve ◽  
Respiratory Impairment ◽  
Major Factors

Background The nasal valve is one of the major factors contributing to nasal airflow obstruction. Physiologically, the nasal valve offers the greatest resistance to nasal airflow and generally functions as an inflow device controlling nasal airflow and resistance. Many patients who have complaints of breathing impairment are affected by alterations of the nasal septum, the turbinates, the columellar base, the vestibule floor, or the lateral wall of the nose but may have associated incompetence of the nasal valve, which is too often undervalued by nasal surgeons. The aim of this study was to propose a relatively easy surgical technique to correct most nasal valve impairments associated with nasal septum deviation whether or not there also is inferior turbinate hypertrophy. Methods Between May 2004 and September 2006, 68 patients (26 women and 42 men; mean age, 37 years; range, 16–71 years) underwent primary or secondary functional nasal surgery, because of a nasal respiratory obstruction caused by nasal septal deviation eventually associated with inferior turbinates hypertrophy, and also demonstrated nasal valvular incompetence. A septal cartilage graft was used to correct the valvular incompetence. Results On postoperative visits almost all of the patients (with one exception) showed a remarkable improvement in the stiffening of the valvular region and had only minimal depression of the nostril during deep inspiration. Conclusion This study indicated that septal grafts were useful in the surgical management of nasal respiratory impairment because of nasal valve incompetence, where there had been flaccid mobile collapse of the ala of the nose associated with septal alterations.

scholarly journals Bioabsorbable Implant for Treatment of Nasal Valve Collapse with or without Concomitant Procedures

2021 ◽  
Author(s):  
Douglas M. Sidle ◽  
Pablo Stolovitzky ◽  
Ellen M. O'Malley ◽  
Randall A. Ow ◽  
Nathan E. Nachlas ◽  
...  
Keyword(s):  
Adverse Events ◽  
Nasal Obstruction ◽  
Large Population ◽  
Inferior Turbinate ◽  
Nasal Valve ◽  
Serious Adverse Events ◽  
Vas Scores ◽  
Nasal Implant ◽  
Nasal Valve Collapse

AbstractThe aim of the study is to report outcomes after treatment of nasal valve collapse with a bioabsorbable nasal implant. It involves two prospective, multicenter, post-market studies evaluating long-term effectiveness of the LATERA implant for severe to extreme nasal obstruction. Participants underwent implant alone or with concomitant inferior turbinate reduction (ITR) and/or septoplasty. Outcome measures included the change from baseline Nasal Obstruction Symptom Evaluation (NOSE) scores, NOSE responder rates, visual analog scale (VAS) scores, and adverse events. A total cohort of 277 participants (109 implants only, 67 implants + ITR, 101 implants + septoplasty + ITR) enrolled at 19 U.S. centers was available for analysis with 177 participants (69 implants only, 39 implants + ITR, 69 implants + septoplasty + ITR) available at 2 years. The mean changes from baseline in NOSE scores and VAS scores were statistically significant (p < 0.001) at all follow-up periods. The baseline NOSE score of 77.8 ± 13.6 was improved to 24.2 ± 23.6 at 24 months. Greater than 90% of participants were NOSE responders across all follow-up periods, 6.1% withdrew for lack of treatment effect. The baseline VAS score of 66.7 ± 18.8 was improved to 21.1 ± 23.9 at 24 months. There were no serious adverse events related to the device or implant procedure. Implant retrieval rate was 4.0% (22/543 implants). Nonserious adverse events were mild to moderate in severity, typically occurred within 6 months of implant, and resolved or were stable. Significant reductions in NOSE and VAS scores and high responder rates from our large population of patients with nasal obstruction who had nasal valve implants confirm sustained effectiveness at 24 months after treatment. The studies are registered on www.clinicaltrials.gov (NCT02952313 and NCT02964312).

scholarly journals COMPARISON OF SUB MUCOSAL DIATHERMY AND PARTIAL RESECTION OF INFERIOR TURBINATE IN THE TREATMENT OF SYMPTOMATIC SANAL VALVE BLOCKAGE

2017 ◽  
Vol VOLUME 5 (VOLUME 5 NUMBER 2 JULY 2017) ◽  
pp. 15-17
Author(s):  
Kapil kumar Singh
Keyword(s):  
Airway Resistance ◽  
Upper Airway ◽  
Inferior Turbinate ◽  
Partial Resection ◽  
Nasal Packing ◽  
Nasal Valve ◽  
Nasal Blockage ◽  
Group I ◽  
Group 2

OBJECTIVEES: To evaluate the efficacy of sub mucosal diathermy (SMD) and partial resection of inferior turbinate (PRIT) in the treatment of symptomatic enlarged inferior turbinate. STUDY DESIGN: Prospective, METHODS: Sixty patents at age group 18 -56 yrs. with symptomatic enlarged inferior turbinate had given choices for SMD and PRIT. All the patients had history of failed medical treatment. RESULTS: Each thirty patients underwent SMD (group I), PRIT (group II), eight patients of group l, have anterior nasal packing after surgery for bleeding. Four patients complained of excessive rhinorrhea for first 2 weeks while 4 patients of Group 1 complained of nasal blockage for 1 week even after intervention. In group 2, 8 patients have re-anterior nasal packing after pack removal. Both groups followed up for 6 months. 13 patients were lost in follow up, so excluded from the study. Following 6 months of follow up, 8 patient of group I had recurrence with nasal blockage and in gr. II none had recurrence. CONCLUSION: PRIT is better than SMD in long course; nevertheless it should be reserved for failed SMD, not as a primary option. Ink described the nasal valve in 1903. The nasal valve is formed medially by the septum and laterally by the caudal edge of the upper lateral cartilage and it accounts for approximately 50% of total upper airway resistance. The anterior tip of the inferior turbinate is found in the nasal valve region, and hypertrophy of this structure can cause exponential increase in airway resistance.

scholarly journals Alar Batten Grafts for Non-iatrogenic Nasal Valve Area/Alar Collapse

2009 ◽  
Vol 2 (3) ◽  
pp. 1-4 ◽  
Author(s):  
C Ekambar E Reddy ◽  
Trevor Teemul ◽  
Sucha Hampal ◽  
Krishna TV Reddy
Keyword(s):  
Nasal Obstruction ◽  
Septal Cartilage ◽  
Nasal Valve ◽  
Lower Lateral Cartilage ◽  
Modified Technique ◽  
Deviated Nasal Septum ◽  
Graft Size ◽  
Graft Extrusion ◽  
Valve Area

ABSTRACT Objectives We present our 3 years experience with alar batten grafts, using a modified technique, for non-iatrogenic nasal valve/alar collapse. Methods Retrospective (Oct. 2005 to Apr. 2008) and prospective study (Apr. 2008 to Dec. 2008) of 16 consecutive patients undergoing alar batten grafts for alar collapse causing nasal obstruction. The graft was inserted through a rim incision and placed across as well as superficial to the lower lateral cartilage. The main outcome measures were subjective improvement in nasal obstruction and absence of alar collapse at examination. Results Alar collapse was bilateral (n = 8), right sided (n = 4) and left sided (n = 4) giving 24 operated sides (s = 24). Deviated nasal septum (n = 9), synechiae (n = 1) and drooping tip (n = 1) were also present. Donor sites for the graft were septal cartilage (n = 10), conchal cartilage (n = 4) or both septal and conchal cartilages (n = 2). The median follow-up was 4 months (range 1 month to 3 years). Subjective nasal obstruction had worsened in 0%, was unchanged in 16.6% (s = 4), had improved in 16.6% (s = 4) and 66.6% (s = 16) were completely free of obstruction. Two of the improved cases worsened at 10 and 3 years giving overall failure in 25% (s = 6). Significant alar collapse was present in all failed cases and absence of collapse was documented in improved cases (s = 13). In failed cases the graft size width was 5 to 8 mm and in successful cases it was 10 to 15 mm. Lengths of the grafts in all cases was between 18 and 24 mm. One complication of graft extrusion through skin occurred. Conclusion Our technique of alar batten graft insertion appears to be as effective as other techniques described in the literature. We suggest a minimum graft size of 10 mm width and 18 mm length to improve success rate.

scholarly journals A 2-Year Follow-up Study of an Absorbable Implant to Treat Nasal Valve Collapse

2018 ◽  
Vol 34 (05) ◽  
pp. 545-550 ◽  
Author(s):  
Marion San Nicoló ◽  
Klaus Stelter ◽  
Haneen Sadick ◽  
Murat Bas ◽  
Alexander Berghaus
Keyword(s):  
Symptom Improvement ◽  
Lateral Nasal Wall ◽  
Lateral Cartilage ◽  
Nasal Valve ◽  
Follow Up Study ◽  
Acid Copolymer ◽  
Absorbable Implant ◽  
The Mean ◽  
Nasal Valve Collapse

AbstractThe safety and effectiveness of an absorbable implant for lateral cartilage support have been recently demonstrated in subjects with nasal valve collapse (NVC) at 12 months postprocedure. This follow-up study aimed to assess whether the safety and effectiveness of the implant persist in these patients for 24 months after the procedure. Thirty subjects with Nasal Obstruction Symptom Evaluation (NOSE) score ≥ 55 and isolated NVC were treated; 14 cases were performed in an operating suite under general anesthesia and 16 cases were performed in a clinic-based setting under local anesthesia. The implant, a polylactic acid copolymer, was placed with a delivery tool within the nasal wall to provide lateral cartilage support. Subjects were followed up through 24 months postprocedure. Fifty-six implants were placed in 30 subjects. The mean preoperative NOSE score was 76.7 ± 14.8, with a range of 55 to 100. At 24 months, the mean score was 32.0 ± 29.3, reflecting an average within-patient reduction of −44.0 ± 31.1 points. There were no device-related adverse events in the 12 to 24 months period. There were five subjects who exited the study prior to the 24-month follow-up. Four of the five subjects who exited were elected for further intervention and one subject was lost to follow-up. This study demonstrates safety of an absorbable implant for lateral nasal wall support and symptom improvement in some subjects with NVC at 24 months postprocedure.

Pyriform Aperture Enlargement for Internal Nasal Valve Obstruction in Adults: Systematic Review and Surgical Classification

2021 ◽  
pp. 019459982199473
Author(s):  
Humoud Hajem ◽  
Charles Botter ◽  
Mohammad Al Omani ◽  
Vincent Sounthakith ◽  
Eléonore de Bressieux ◽  
...  
Keyword(s):  
Systematic Review ◽  
Nasal Obstruction ◽  
Surgical Techniques ◽  
Major Complication ◽  
Inferior Turbinate ◽  
Lateral Nasal Wall ◽  
Safe Procedure ◽  
Nasal Valve ◽  
Level Of Evidence ◽  
Pyriform Aperture

Objective Pyriform aperture enlargement or “pyriplasty” is an uncommonly used procedure for internal nasal valve obstruction in adults besides functional rhinoplasty, inferior turbinate reduction, and septoplasty. A systematic review of the literature was performed to analyze current surgical techniques, their suggested indications, and their related outcome in terms of success and complications. Data Sources The search was performed on PubMed, EMBASE, SCOPUS, and Cochrane databases. Review Methods The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies on congenital, traumatic, tumoral, or infectious internal nasal valve obstruction were excluded. Results Eight articles were finally included. Three types of pyriplasty have been described according to the level of bone resection: low-level pyriplasty through the sublabial approach, mid-level pyriplasty through endonasal approach, and extended pyriplasty through either approach. Indications included (1) clinically or radiologically narrow pyriform aperture, (2) previously unsuccessful internal nasal valve surgery, (3) lateral nasal wall collapse, and (4) inferior turbinate’s head hypertrophy. Subjective improvement of nasal obstruction was reported in these 4 indications. No major complication was encountered. Conclusion Pyriplasty for nasal obstruction is a simple and safe procedure that could be effective in selected cases. However, level of evidence is currently low, and success rate may vary with indications and pyriplasty techniques. Moreover, there is no clear definition of normal pyriform aperture dimensions to date. Further prospective studies are thereby necessary and should include radiological analysis of pyriform aperture and validated nasal obstruction measurement tools.

Caudal Septoplasty for Treatment of C-Shaped Craniocaudal Deviation Using Synthetic Struts

2016 ◽  
Vol 34 (1) ◽  
pp. 50-54
Author(s):  
Daniel G. Moina ◽  
Gabriel Moina ◽  
Alberto Rancati
Keyword(s):  
Inferior Turbinate ◽  
Septal Cartilage ◽  
Septal Deviation ◽  
Functional Improvement ◽  
Aesthetic Results ◽  
The Mean ◽  
Cartilage Grafting ◽  
Pds Foil

We describe our technique using polydioxanone (PDS) foil for the correction and stabilization of caudal septal deviation. In addition, we evaluate the effectiveness of this technique in the treatment of the C-shaped craniocaudal sepal deviation. A retrospective review was conducted of 55 patients who underwent open septorhinoplasty with PDS splinting for the correction of a caudal septal deviation. The mean age was 35 years (range, 25-45 years), 38 of 55 (69%) were females and all had symptomatic nasal obstruction. Preoperatively, there were osteocartilaginous involvement and hypertrophy of the inferior turbinate at the opposite side of the septal deviation in all cases; whereas 30 (54.5%) patients had a bone spur, 20 (36.3%) had collapse of the external nasal valve due to septal deviation. Five patients complained of sinus headache that resolved after surgical correction. All patients were pleased with their functional improvement and 52 (95%) with their aesthetic results. Only 1 patient required surgical revision, which was due to the development of asymptomatic posterior septal perforation identified at follow-up endoscopy. There were no additional postoperative complications. Splinting of the septal cartilage with a PDS foil was feasible, safe, and effective for the treatment of severe caudal septal deviation. This technique emerges as an alternative to traditional cartilage grafting, especially in patients with insufficient cartilage for harvest or in patients with thin nasal dorsum in whom the use of a spreader graft can widen the nose and modify the normal nose contours, providing long-term support and stability of the septum.

Magnetic Resonance Imaging of the Nasal Airways

1989 ◽  
Vol 3 (2) ◽  
pp. 63-67 ◽  
Author(s):  
Philip Cole ◽  
James S. J. Haight ◽  
Kensai Naito ◽  
Walter Kucharczyk
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Inferior Turbinate ◽  
Lateral Nasal Wall ◽  
Nasal Valve ◽  
Resonance Imaging ◽  
Nasal Airways ◽  
Airway Lumen ◽  
Anterior Septum ◽  
Lateral Recumbency

Magnetic resonance imaging was used to demonstrate both erectile tissues and airway lumen of the nasal cavities together with their responses to lateral recumbent postures and to topical decongestant. The inferior turbinate and the anterior septal body responded to lateral recumbency by swelling in the inferior nasal cavity and reciprocal shrinking in the superior side and both responded to topical decongestant by shrinking. Converse changes in airway lumen took place in each case. In the untreated nose erectile tissues of the lateral nasal wall appeared to adapt to septal irregularities and to maintain a uniform width of the airway lumen in the more patent side. Erectile tissues on the lateral nasal wall anterior to the inferior turbinate and medially on the anterior septum were seen to intrude on the constricted region of the nasal valve where their potential to exert a critical influence on airflow resistance was evident.

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