Costal Cartilage Lateral Crural Strut Graft for Correction of External Nasal Valve Dysfunction in Primary and Revision Rhinoplasty

Objective: To evaluate and compare the costal cartilage lateral crural strut graft’s (LCSG) ability to support a weak lateral crus in patients with external nasal valve dysfunction (EVD) undergoing primary versus revision functional rhinoplasty. Methods: This is a prospective cohort study of 26 patients (mean [SD]: 40.23 [6.75] years of age; 10 [38%] females) with clinically diagnosed EVD, who underwent primary versus revision functional rhinoplasty with the use of a costal cartilage LCSG (10 [38%] primary functional rhinoplasty patients and the 16 [62%] revision patients). Preoperative and 12-month postoperative subjective and objective functional measurements along with statistical analysis were performed. Results: While all baseline demographic and preoperative functional measurement scores were similar between the 2 groups, the primary cohort’s preoperative scores were higher overall. Follow-up was a mean of 14.58 months. The primary group demonstrated a greater difference in score improvement postoperatively in all categories. All patients had significantly improved visual analog scale (VAS), Nasal Obstruction Symptom Evaluation Scale, 22-Item Sinonasal Outcome Test, and nasal peak inspiratory flow (NPIF) scores. When comparing the overall score outcome and surgical efficacy of the LCSG, both groups had near equal final score outcomes with the exception of VASL and NPIF. Conclusion: The LCSG is a viable and versatile option in the management of EVD for both primary and revision rhinoplasty patients.

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Airflow and Patient-Perceived Improvement Following Rhinoplastic Correction of External Nasal Valve Dysfunction

JAMA Facial Plastic Surgery ◽

10.1001/jamafacial.2014.1456 ◽

2015 ◽

Vol 17 (2) ◽

pp. 131-136 ◽

Cited By ~ 15

Author(s):

Tom Palesy ◽

Eleanor Pratt ◽

Nadine Mrad ◽

George N. Marcells ◽

Richard J. Harvey

Keyword(s):

Nasal Valve ◽

Valve Dysfunction ◽

External Nasal Valve

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Revision Rhinoplasty: Retrospective Chart Review Analysis of Deformities and Surgical Maneuvers in Patients with Nasal Airway Obstruction—Five Years of Experience

Facial Plastic Surgery ◽

10.1055/s-0037-1598041 ◽

2017 ◽

Vol 33 (03) ◽

pp. 334-338 ◽

Cited By ~ 7

Author(s):

Dimitrios Daskalakis ◽

Kalpesh Patel ◽

John Goudakos

Keyword(s):

Airway Obstruction ◽

Chart Review ◽

Retrospective Chart Review ◽

Lateral Wall ◽

Nasal Airway ◽

Nasal Valve ◽

Valve Dysfunction ◽

Septum Deviation ◽

Review Analysis ◽

Revision Rhinoplasty

AbstractNasal airway obstruction is one of the most frequent causes of revision rhinoplasty in patients after previous rhinoplasty procedure. Purpose of this study is to present the deformities and the surgical maneuvers conducted in revision rhinoplasty patients with functional complaint, anatomical sites at risk, and potential prophylactic maneuvers. This study is a retrospective chart review analysis of 46 consecutive revision rhinoplasty procedures in patients with nasal airway obstruction. Inclusion criteria were at least one previous rhinoplasty and nasal airway obstruction as the epicenter of patients' complaint. Thorough clinical examination to certify the obstruction was performed. Deformities noted were separated in three categories according to functional, cosmetic, and combination of functional and cosmetic implications. Surgical maneuvers conducted were reviewed. Deformities found were checked for statistically significant coexistences. The average patient age was 34.9 years. The mean number of previous septorhinoplasties was 1.33. Nasal ventilation obstruction mainly caused either by septum deviation or nasal valve dysfunction was identified in 91.3% of our patients. Surgical maneuvers conducted included placement of grafts in 89.1% of all cases, septoplasty in 76.1%, lateral wall support in 47.8%, and placement of spreader grafts in 39.1% of patients. The average preoperative Nasal Obstruction Symptom Evaluation (NOSE) score was 61 ± 15 and it improved substantially, even from month 1, postoperatively. Owing to high prevalence of nasal airway obstruction after primary or secondary rhinoplasty, we conducted the first retrospective chart review study to identify the most common deformities in revision rhinoplasty patients with nasal airway obstruction and the appropriate surgical maneuvers to address them. Septum deviation and nasal valve dysfunction were the two pillars of nasal airway obstruction in those patients.

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Management of External Nasal Valve Collapse: Literature Review

International Journal of Medical and Surgical Sciences ◽

10.32457/ijmss.v7i1.481 ◽

2020 ◽

pp. 47-54

Author(s):

Libia Avila Campoverde ◽

Deniss Calderón Alemán ◽

Doris Calderón Alemán ◽

Mónica Tello Larriva ◽

Mayra Montecinos Rivera

Keyword(s):

Clinical Evidence ◽

Correct Diagnosis ◽

Lateral Wall ◽

Alar Cartilage ◽

Effective Management ◽

Nasal Valve ◽

Valve Dysfunction ◽

The World ◽

Nasal Valve Collapse ◽

External Nasal Valve

Rhinoplasty is one of the most frequent cosmetic surgeries in the world and among the most common complications is valve collapse due to excessive resection of the alar cartilage. Facial paralysis, as well as aging, can collapse the lateral wall in inspiration due to dysfunction of the nasal muscle, causing weakening of the fibroalveolar tissue of the nasal lateral wall, and there are also genetic causes that produce valve collapse. Currently, various techniques are practiced to improve valve collapse and none are one hundred percent effective, most of them focus on correcting the nasal valve itself or the triangular cartilage, which indicates that they are fixed on a single factor and not on multifactorial etiology that produces it. This study reviews the clinical evidence that guides a correct diagnosis and effective management of external nasal valve dysfunction, using various techniques that are currently used to improve nasal valve collapse.

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Semi-wrapping lateral cartilage to a square edged strut perpendicularly to prevent collapse in external nasal valve dysfunction: pseudodome technique

The European Research Journal ◽

10.18621/eurj.376421 ◽

2018 ◽

Author(s):

Muhammed Yanılmaz ◽

Davut Akduman

Keyword(s):

Lateral Cartilage ◽

Nasal Valve ◽

Valve Dysfunction ◽

External Nasal Valve

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A Follow-up Study of the Monarch Adjustable Implant for Correction of Nasal Valve Dysfunction

Archives of Facial Plastic Surgery ◽

10.1001/archfaci.10.2.142 ◽

2008 ◽

Vol 10 (2) ◽

pp. 142-143 ◽

Cited By ~ 6

Author(s):

C. G. Hurbis

Keyword(s):

Nasal Valve ◽

Valve Dysfunction ◽

Follow Up Study

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Modified alar batten grafts for treatment in nasal valve dysfunction: Our experience.

Auris Nasus Larynx ◽

10.1016/j.anl.2021.08.006 ◽

2021 ◽

Author(s):

Alberto Raposo ◽

Jerónimo Lajara ◽

Alberto Guillén ◽

Francisco García-Purriños

Keyword(s):

Nasal Valve ◽

Valve Dysfunction

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An Adjustable Implant for the Nasal Valve: 3-Year Experience

Otolaryngology ◽

10.1016/j.otohns.2008.05.233 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P72-P72

Author(s):

Charles G Hurbis

Keyword(s):

Nasal Valve ◽

Valve Dysfunction ◽

Nasal Airways ◽

Quality Of Life Scale ◽

Life Scale ◽

Nasal Implant ◽

Scale Data ◽

Implantation Success

Objective 1) Measure the effectiveness of the Monarch implant in correcting nasal valve dysfunction. 2) Determine the longevity of effectiveness. Methods This study consists of a prospective, cumulative, three-year experience with the Monarch adjustable nasal implant for correcting nasal valve dysfunction in a total of 46 patients. Implantation success was determined by the use of acoustic rhinomanometry and a subjective NOSE-type quality of life scale. Data was subjected to the student-t test. Results In the series of 46 patients spanning 36 months there is a mean 150% improvement in the internal nasal valve areas at 3 years as measured by acoustic rhinomanometry (p<.0001). Using a NOSE-type questionnaire, patients also noted significant improvements in daytime (p<.0004) and nighttime (p<.0002) nasal airways, a decrease in apnea (p<.01) and snoring (p<.05), and a decrease in the propensity for daytime oral breathing (p<.0002). Conclusions The Monarch Implant provides a simple, consistent, adjustable and apparently long-term correction of the nasal airway in patients suffering from nasal valvular dysfunction.

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Safety and Efficacy of Non- and Minimally Irradiated Homologous Costal Cartilage in Primary and Revision Rhinoplasty

Facial Plastic Surgery & Aesthetic Medicine ◽

10.1089/fpsam.2020.0031 ◽

2020 ◽

Author(s):

Joelle Rogal ◽

Alvin Glasgold ◽

Robert A. Glasgold

Keyword(s):

Costal Cartilage ◽

Safety And Efficacy ◽

Revision Rhinoplasty

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Severe iatrogenic nostril stenosis

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.173131 ◽

2015 ◽

Vol 48 (03) ◽

pp. 305-308 ◽

Cited By ~ 2

Author(s):

Ali Ebrahimi ◽

Amin Shams

Keyword(s):

Literature Review ◽

Medical History ◽

Female Patient ◽

Past Medical History ◽

Nasal Valve ◽

Nasal Deformity ◽

Nasal Airways ◽

Congenital Lesions ◽

External Nasal Valve

ABSTRACTNostril stenosis (narrowing of the nasal inlet) is an uncommon deformity which results in aesthetic and breathing discomfort in patients. The literature review shows that trauma, infection, iatrogenic insults and congenital lesions are major causes of stenosis. Nowadays, rhinoplasty is one of most popular aesthetic surgeries which may have complications such as bleeding, swelling, bruising, asymmetry, obstruction of nasal airways. We present a 30-year-old female patient, who complained about breathing and aesthetic difficulties due to external nasal valve obstruction and nasal deformity. Past medical history showed that the patient had undergone three unsuccessful rhinoplasty surgeries with aesthetic goals.

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