Clinical consensus statement: Diagnosis and management of nasal valve compromise

Abstract

Objective To create a clinical consensus statement to address ambiguities and disparities in the diagnosis and management of nasal valve compromise (NVC). Methods An updated systematic review of the literature was conducted. In addition, a Modified Delphi Method was used to refine expert opinion and facilitate a consensus position. Results After two rounds of surveys and conference calls, thirty six items reached consensus, six items reached near consensus, and ten items reached no consensus. The categories that had the greatest percentage of consensus or near consensus items were: definition, history and physical examination, outcome measures, and management. Conversely, the categories with greater percentage of no consensus items were: adjunctive tests and coding. Conclusions The consensus panel agreed that NVC is a distinct clinical entity that is best evaluated with history and physical exam findings. Endoscopy and photography are useful but not routinely indicated, while radiographic studies are not useful in evaluating NVC. Other objective nasal outcome measures may not be useful or accepted for NVC. Nasal steroid medication is not useful for treating NVC in the absence of rhinitis, and mechanical treatments may be useful in selected patients. Surgical treatment is the primary mode of treatment of NVC, but bill coding remains ambiguous and confusing.

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

“…61 Techniques such as static and dynamic inspection, the modified Cottle maneuver (as depicted in Figure 5), 62 and palpation can augment the physical examination. 60,[63][64][65] Furthermore, the rhinoplasty surgeon should be cognizant of the dynamic nature of the operation and consider how attempts to alter the aesthetic appearance of the nose may affect nasal airway obstruction. For example, careful evaluation of the strength of the nasal tip and lower lateral cartilages is important, as too much resection in the setting of weak cartilage can lead to postoperative nasal obstruction.…”

The Impact of Alveolar Bone Grafting on Cleft Lip and Palate: A literature review

“…67 In non-cleft subjects the minimum cross sectional area and thus the area of highest resistance to air ow is located at the nasal valve. is area approximates to the region of the anterior head of inferior turbinate 68 and is closely related to surgical area that receives the graft. Lino et al 69 suggested partial inferior turbinectomy during secondary alveolar bone grafting to facilitate formation of a su cient bone bridge although no comment is made as to its e ect on the nasal airway.…”

Válvula nasal en rinoplastía

“…De toda la zona valvular, la válvula interna se considera como el segmento más estrecho y la zona de máxima resistencia en la vía aérea 3,10 . La válvula externa por su parte, se refiere clásicamente al área del vestíbulo nasal delimitada por el septum caudal, crura medial de los cartílagos alares y reborde alar 11 . La definición de ésta lamentablemente no ha sido consistente en la literatura, dando origen a mucha controversia.…”

“…La endoscopía nasal es un coadyuvante en el diagnóstico, de mucha utilidad en cirugía de revisión, para localizar adecuadamente zonas de sinequias posteriores y observar en forma dinámica aquellos sitios de colapso intranasal 11,[13][14][15] .…”