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 Criteria for Defining ‘Severe Septal Deviation’

2014 ◽  
Vol 5 (1) ◽  
pp. 6-8
Author(s):  
Rahil Muzaffar ◽  
Owais Mattoo ◽  
Raja Salman Khurshid ◽  
Shafqat Islam
Keyword(s):  
Nasal Obstruction ◽  
Septal Deviation ◽  
Nasal Discharge ◽  
List Type ◽  
Nasal Valve ◽  
Deviated Nasal Septum ◽  
Evaluation Scores ◽  
Symptom Evaluation ◽  
External Nasal Deformity ◽  
Valve Area

ABSTRACT Objective Criteria for defining ‘severe septal deviation’ and to describe the clinical profile of the same. Study Retrospective study. Materials and methods Hundred patients who were diagnosed with severe DNS and treated with extracorporeal septoplasty (ECSP) from September 2010 to December 2012, were retrospectively evaluated for this study. A review of their clinical charts formed the basis of this study. Results In this study, majority of patients (96%) had nasal obstruction as their prime symptom followed by postnasal discharge in 60% cases, headache in 40% cases and anterior nasal discharge in 30% cases. External nasal deformity was reported by 22 patients. Snoring was seen in 24% of patients with same percentage complaining of altered sense of smell and throat discomfort. Epistaxis, sneezing and facial pain were seen in 14% patients. Epiphora was complained by only 8% of patients. In this study, nasal endoscopy/anterior rhinoscopy was used to type the septal deformity. The commonest septal deviation was C-shaped cephalocaudal (48%), followed by S-shaped cephalocaudal (18%), C-shaped AP (16%), S-shaped AP (12%) and sharp septal deviation/angulation in 6% cases. All but three patients (6%) had deviated nasal septum involving multiple Cottle's areas. These three patients had sharp septal angulation involving Cottle's area 2 only. In this study, most common region involving DNS was area 1 + 2 + 3 (48%) followed by area 2 + 4 + 5 (28%) and 1 + 2 + 3 + 4 (18%). Area 2 was invariably involved in 100% of cases. NOSE (nasal obstruction symptom evaluation) scores. Preoperatively, mean NOSE score was 67.60 ± 5.26 (65.34-72.86). NSS (nasal symptoms score): – Preoperatively, mean NSS was –5.08 ± 0.38 (–5.46-–4.70). Conclusion A septal deviation is regarded as ‘severe’ if patient satisfies all of the below-mentioned criteria: – Preoperatively, mean NOSE score should be 65.34 or more. Preoperatively, mean NSS should be –4.70 or more negative. The septal deviation must cause significant obstruction to Cottle's area 2 or nasal valve area. Patients of severe septal deviation report significantly higher rates of snoring (24% in our study) and PND (60% in our study) when compared with mild/moderate cases. All severe septal deviations display significant obstruction of Cottle's area 2/nasal valve area and it is thus concluded that a severe septal deviation must cause significant obstruction of area 2/nasal valve. How to cite this article Mattoo O, Muzaffar R, Khurshid RS, Islam S. Criteria for Defining ‘Severe Septal Deviation’. Int J Head Neck Surg 2014;5(1):6-8.

Spreader Graft for Severe Deviation of Nasal Septum with Obstruction of the Internal Nasal Valve: Clinical and Functional Results

2020 ◽  
Vol 36 (05) ◽  
pp. 635-642
Author(s):  
Leandro Albergo ◽  
Ernesto Desio ◽  
Velia Elena Revelli ◽  
Micaela B. Acosta
Keyword(s):  
Nasal Obstruction ◽  
Correct Diagnosis ◽  
Functional Results ◽  
Functional Improvement ◽  
Endonasal Approach ◽  
Nasal Valve ◽  
Spreader Graft ◽  
Symptom Evaluation ◽  
Valve Area

AbstractDifficulty in nasal ventilation is one of the most frequently occurring problems in otorhinolaryngology and its correct diagnosis is the key step to solve it. The dysfunctions in the valve area are a frequent cause of chronic nasal obstruction, though commonly ignored. The objective of the study is to analyze the clinical and functional outcomes in a group of patients with septal deviations and valve compromise treated with spreader graft with endonasal approach. Thirty-five patients with septal deviation with compromise of the internal nasal valve (INV; area II of Cottle), treated with spreader graft and a minimum follow-up of 12 months, were included for analysis. Patients were evaluated with video nasosinusal endoscopy, photography, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and rhinomanometry (RM). Postoperative complications were recorded. The results obtained in the pre- and postoperative NOSE scores showed significant differences (p = 0.001), as also in pre- and postoperative RM tests (p < 0.001). Two complications were reported in the 35 patients; thus the complication rate in our sample was 6%. The use of spreader grafts, with endonasal approach, as nasal septum's tutors improved perpendicular septal deviations with compromise of the INV (area II), reaching an effective functional improvement in the nasal airway, with low rate of complications.

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).

The Role of Outfracture in Correcting Post-Rhinoplasty Nasal Obstruction

1998 ◽  
Vol 77 (2) ◽  
pp. 106-112 ◽  
Author(s):  
Jonathan Pontell ◽  
David H. Slavit ◽  
Eugene B. Kern
Keyword(s):  
Patient Satisfaction ◽  
Surgical Technique ◽  
Nasal Obstruction ◽  
Patient Selection ◽  
Clinical Results ◽  
Nasal Valve ◽  
Cadaver Dissection ◽  
Valve Area

Post-rhinoplasty nasal obstruction is often related to narrowing in the region of the nasal valve. Correction of this obstruction can include inferior turbinectomy, septoplasty spreader grafts and nasal valvuloplasty. The authors have seen cases of severe valve stenosis related to infracture after osteotomy which did not respond to any of the aforementioned procedures. These patients were treated with revision osteotomy with outfracture. We discuss patient selection and surgical technique for revision osteotomy with outfracture as well as a cadaver dissection demonstrating the effects of infracture and outfracture on valve area. The clinical results, based on patient satisfaction and pre- and postoperative photographs, are presented. Revision osteotomy with outfracture should be included in the surgeon's armamentarium for the treatment of post-rhinoplasty nasal obstruction.

Acoustic Rhinometric Assessment of the Nasal Valve

1997 ◽  
Vol 11 (5) ◽  
pp. 379-386 ◽  
Author(s):  
Renato Roithmann ◽  
Jerry Chapnik ◽  
Noe Zamel ◽  
Sergio Menna Barreto ◽  
Philip Cole
Keyword(s):  
Cross Section ◽  
Nasal Obstruction ◽  
Cross Sectional Area ◽  
Acoustic Rhinometry ◽  
Sectional Area ◽  
Nasal Valve ◽  
Cross Sectional ◽  
Nasal Cavities ◽  
Before And After ◽  
Valve Area

The aims of this study are to assess nasal valve cross-sectional areas in healthy noses and in patients with nasal obstruction after rhinoplasty and to evaluate the effect of an external nasal dilator on both healthy and obstructive nasal valves. Subjects consisted of (i) volunteers with no nasal symptoms, nasal cavities unremarkable to rhinoscopy and normal nasal resistance and (ii) patients referred to our clinic complaining of postrhinoplasty nasal obstruction. All subjects were tested before and after topical decongestion of the nasal mucosa and with an external nasal dilator. In 79 untreated healthy nasal cavities the nasal valve area showed two constrictions: the proximal constriction averaged 0.78 cm2 cross-section and was situated 1.18 cm from the nostril, the distal constriction averaged 0.70 cm2 cross-section at 2.86 cm from the nostril. Mucosal decongestion increased cross-sectional area of the distal constriction significantly (p < 0.0001) but not the proximal. External dilation increased cross-sectional area of both constrictions significantly (p < 0.0001). In 26 post-rhinoplasty obstructed nasal cavities, only a single constriction was detected, averaging 0.34 cm2 cross-section at 2.55 cm from the nostril and 0.4 cm2 at 2.46 cm from the nostril, before and after mucosal decongestion respectively. External dilation increased the minimum cross-sectional area to 0.64 cm2 in these nasal cavities (p < 0.0001). We conclude that the nasal valve area in patients with postrhinoplasty nasal obstruction is significantly smaller than in healthy nasal cavities as shown by acoustic rhinometry. Acoustic rhinometry objectively determines the structural and mucovascular components of the nasal valve area and external dilation is an effective therapeutical approach in the management of nasal valve obstruction.

Auricular Perichondrium Graft for Septal Perforation Repair

2021 ◽  
pp. 000348942110157
Author(s):  
Stephen F. Bansberg ◽  
Cullen M. Taylor ◽  
Gregory S. Neel
Keyword(s):  
Nasal Obstruction ◽  
Graft Material ◽  
Septal Perforation ◽  
Nasal Valve ◽  
Auricular Cartilage ◽  
Interposition Graft ◽  
Presenting Symptoms ◽  
Septal Surgery ◽  
Record Review

Objectives: Procedures which utilize bilateral mucosal flaps with an interposition graft are frequently used when attempting closure of a septal perforation. Concurrent surgical management of the nasal valve or an aesthetic deformity may be indicated. The objective of this study is to report our experience using auricular perichondrium for the interposition graft when auricular cartilage is harvested for structural or aesthetic graft material. Methods: A retrospective medical record review was performed for septal perforation repairs performed at Mayo Clinic in Arizona from January 2010 through January 2020. Patients identified for this study underwent a procedure utilizing bilateral nasal mucosal flaps with an auricular perichondrium interposition graft. Results: Forty-four patients (31 females) with a mean age of 53.3 years met study criteria. The most common presenting symptoms were nasal obstruction, crusting, and epistaxis. Prior septal surgery was the most common perforation etiology (45.5%). Mean perforation length was 11.8 (range, 3-26) mm and height, 9.1 (range, 2-16) mm. Auricular cartilage was harvested for nasal valve surgery in 43 patients. Complete perforation closure was noted in 95.3% (41/43) of patients with a minimum post-operative follow-up of 3 (mean, 20.4) months. Four patients underwent revision surgery for persistent postoperative nasal obstruction. Conclusion: The ear can provide both cartilage and perichondrium for use in septal perforation surgery. Our study demonstrates the successful use of auricular perichondrium as the interposition graft for a perforation closure procedure utilizing bilateral nasal mucosal flaps.

scholarly journals Bilateral congenital aplasia of nasal lower lateral cartilage: a rare anomaly

2020 ◽  
Vol 13 (1) ◽  
pp. e231905 ◽  
Author(s):  
Kapil Soni ◽  
Darwin Kaushal ◽  
Bikram Choudhury ◽  
Ranjit Kumar Sahu
Keyword(s):  
Septal Cartilage ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Difficulty Breathing ◽  
Aesthetic Results ◽  
Congenital Aplasia ◽  
Grafting Through ◽  
Cartilage Grafting ◽  
External Rhinoplasty

Congenital nasal anomalies are rare and occur in 1/20 000–1/40 000 newborns. An 8-year-old boy presented with developmental aplasia of bilateral nasal lower lateral cartilages, with excessive wrinkled and loose skin on the dorsum of the nose and with difficulty breathing through the nose. This is probably the first such case to be reported in the literature. The defect was reconstructed using conchal and septal cartilage grafting through an external rhinoplasty approach. At the end of the 12-month follow-up period, the patient was found to be satisfied with the functional and aesthetic results of the operation. Bilateral congenital aplasia of nasal lower lateral cartilages is extremely rare. Paediatric rhinoplasty is imperative in such cases.

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.

scholarly journals AYURVEDIC MANAGEMENT OF DEVIATED NASAL SEPTUM – A CASE STUDY

2021 ◽  
Vol p5 (03) ◽  
pp. 2864-2867
Author(s):  
Indu Sharma ◽  
Shamsa Fiaz
Keyword(s):  
Nasal Obstruction ◽  
Nasal Septum ◽  
Severe Bleeding ◽  
Nasal Discharge ◽  
Deviated Nasal Septum ◽  
Contemporary Science ◽  
Rhinitis Sicca ◽  
Septal Abscess

Nasa Pratinaha is one among the 31 Nasa Roga in which nasal obstruction is the main symptom. It is a commonly encountered disease in clinical practice. This disease occurs due to aggravation of Udan Vata, enveloped with Kapha, thereby causing obstruction in nose. In contemporary science this disease can be co-related with many disorders like turbinate hypertrophy, deviated nasal septum, nasal polyp, tumours, allergic rhinitis and others; among which deviated nasal septum is a common cause. Deviated Nasal Septum can be treated with surgical and medical methods. The medical and surgical managements have their own limitations, merits, and demerits like synechiae formation, rhinitis sicca, severe bleeding, septal perforation, septal heamatoma, septal abscess etc. In Ayurvedic classics the treatment for Nasa Pratinaha is Snehapana, Nasya, Dhoompana etc. The best prescribed in Nasya Pratinaha for Nasya is Bala Taila, the same oil is also recommended for Nasa Pichu. Thus, this study was carried out with the objective of to evaluate the effectiveness of Bala Taila Nasya and Nasa Pichu in the management of Deviated Nasal Septum Nasal Septum. A case report of 43-year-old female who presented with complaints of frequent nasal obstruction, nasal discharge, discomfort in nose, and headache; was diagnosed with Deviated Nasal Septum. The patient was treated with Bala Taila nasya and Nasa Pichu with the same oil. Hence Bala Taila administered as Nasya and Nasa Pichu was significant in controlling the symptoms of Nasa Pratinaha (Deviated Nasal septum) without recurrence in the follow up period.

scholarly journals Role of Bilateral Inferior Turbinoplasty as an Adjunct to Septoplasty in Improving Nasal Obstruction and Subjective Performance in Patients With Deviated Nasal Septum Associated With Allergic Rhinitis: An Interventional, Prospective Study

2021 ◽  
pp. 014556132110154
Author(s):  
Sanjoy Kumar Ghosh ◽  
Mainak Dutta ◽  
Dibakar Haldar
Keyword(s):  
Allergic Rhinitis ◽  
Prospective Study ◽  
Nasal Obstruction ◽  
Nasal Septum ◽  
Inferior Turbinate ◽  
Significant Benefit ◽  
Rank Test ◽  
Performance Parameters ◽  
Deviated Nasal Septum

Background: Patients with nasal obstruction due to deviated nasal septum (DNS) often have allergic rhinitis (AR) as contributing factor. When optimal medical therapy for AR fails, septoplasty alone may not adequately treat nasal obstruction. Therefore, with bilateral inferior turbinate hypertrophy representing long-standing AR, adding bilateral inferior turbinoplasty (BIT) to septoplasty might be beneficial. Objective: To assess whether septoplasty with/without BIT alleviates nasal obstruction in the above patient cohort and whether adding BIT to septoplasty brings significant benefit. Methodology: In this interventional, prospective study, patients with nasal obstruction due to DNS and persistent, moderate-severe AR refractory to optimal medication were randomly allocated into group A (septoplasty alone) and group B (septoplasty with BIT). Nasal Obstruction and Symptom Evaluation (NOSE) score, along with Subjective Performance parameters (days-off/month; number of outdoor visits/month; overall satisfaction score [OSS]) were used to assess the symptom and quality of life, respectively, at follow-up. Results: Each group had 40 age/sex-matched patients. Friedman test, and subsequent pair-wise comparison within groups without Bonferroni correction, revealed that septoplasty with/without BIT elicited significant reduction in NOSE scores and in the Subjective Performance parameters (days-off/month; number of outdoor visits/month) at 3 and 6 months. Wilcoxon Signed Rank test revealed that the OSS within groups also improved significantly with time. Further, comparison between groups revealed significant improvement in NOSE scores at all levels of follow-up when BIT was included. However, there were no significant differences between groups in the Subjective Performance parameters at any level of follow-up. Improvement in OSS between groups was significant only at 3 months but not subsequently. Conclusion: Septoplasty with/without BIT is helpful in treating patients with DNS and refractory AR. However, although adding BIT brings significant benefit in decreasing nasal obstruction, it does not significantly improve the Subjective Performance parameters during follow-up, except for OSS at the third month.

Sign in / Sign up

Export Citation Format

Share Document