The Anterior Spreader Flap: A Minimally Invasive Alternative to the Auto Spreader Flap in the Treatment of Patients with Nasal Valve Dysfunction

Abstract

We present a new method of treatment for nasal valve dysfunction caused by insufficiency or stenosis in a patient who refused open septum revision despite a significant degree of septum deviation. The Anterior Spreader Flap (ASF) technique was suggested as an alternative to open nasal septum revision and was performed under local anesthesia. Computational fluid dynamics (CFD) tests were performed pre-and post-operatively and our patient was asked to complete a self-assessment using a Visual Analog Scale (VAS) for nasal breathing (0 = free nasal breathing, 10 = complete nasal blockage) before and 12 months after surgery. The ASF is a minimally invasive endonasal procedure in which the caudal edge of the upper lateral cartilage is dissected from the septum, and folded inwards and fixed. The ASF allows for less airflow resistance and more free space. CFD techniques revealed a reduction in local pressure based on extended space. In addition, VAS scores improved from 9 to 2 points (right side) and from 8 to 2 points (left side). On the basis of these findings, the ASF technique can be considered a safe, minimally invasive spreader flap technique. It can easily be combined with other nasal surgical techniques, as it is necessary in most cases. In selected cases, the ASF may be performed as a single procedure in patients with nasal valve dysfunction caused by septum deviation as an alternative to open septum revision.