Internal Nasal Valve Incompetence Is Effectively Treated Using Batten Graft Functional Rhinoplasty

The nasal midvault is an important consideration in rhinoplasty. This region is defined by the attachment of the upper lateral cartilages (ULCs) to the nasal bones superiorly and the cartilaginous septum medially. Inadequate management of the nasal midvault can have negative functional and aesthetic ramifications. Indications for midvault reconstruction in primary rhinoplasty include a narrow midvault, dorsal hump resection, a deviated midvault, and an asymmetric midvault, with an additional relative indication of zone 1 lateral wall insufficiency (LWI), defined as dynamic collapse of a weakened lateral nasal wall at the level of the ULC. Numerous techniques for midvault reconstruction have been described, dating back to Sheen's description of the spreader graft in the 1980s, which remains the gold standard for repair. Herein, the various indications for midvault reconstruction are described, along with a discussion of the most commonly used techniques for successful reconstruction.

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“…35 This method has been shown to be an effective means of correcting nasal valve collapse in multiple studies. 12,13,36 Bone-Anchored Sutures…”

Section: Batten Graftmentioning

confidence: 99%

Midvault Reconstruction in Primary Rhinoplasty

2017

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“… 6 , 8 Internal nasal valve incompetence (INVI) is frequently overlooked and incorrectly attributed to other anatomical or physiologic causes. 9 On physical examination, primary anatomic variations to consider are nasal valve narrowing, septal deviation, middle turbinate concha bullosa, inferior turbinate hypertrophy, choanal atresia, pyriform aperture stenosis, posttraumatic adhesions, or previous nasal surgery. 3 , 10 , 11 Some physiologic causes to consider include sino-nasal inflammatory diseases, neoplasms, or medical/hormonal changes.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Functional Rhinoplasty with Spreader Grafting Using Acoustic Rhinomanometry and Validated Outcome Measurements

Paul

Kamali

Chen

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:Rhinoplasty is 1 of the most common aesthetic and reconstructive plastic surgical procedures performed within the United States. Yet, data on functional reconstructive open and closed rhinoplasty procedures with or without spreader graft placement are not definitive as only a few studies have examined both validated measurable objective and subjective outcomes of spreader grafting during rhinoplasty. The aim of this study was to utilize previously validated measures to assess objective, functional outcomes in patients who underwent open and closed rhinoplasty with spreader grafting.Methods:We performed a retrospective review of consecutive rhinoplasty patients. Patients with internal nasal valve insufficiency who underwent an open and closed approach rhinoplasty between 2007 and 2016 were studied. The Cottle test and Nasal Obstruction Symptom Evaluation survey was used to assess nasal obstruction. Patient-reported symptoms were recorded. Acoustic rhinometry was performed pre- and postoperatively. Average minimal cross-sectional area of the nose was measured.Results:One hundred seventy-eight patients were reviewed over a period of 8 years. Thirty-eight patients were included in this study. Of those, 30 patients underwent closed rhinoplasty and 8 open rhinoplasty. Mean age was 36.9 ± 18.4 years. The average cross-sectional area in closed and open rhinoplasty patients increased significantly (P = 0.019). There was a functional improvement in all presented cases using the Nasal Obstruction Symptom Evaluation scale evaluation.Conclusions:Closed rhinoplasty with spreader grafting may play a significant role in the treatment of nasal valve collapse. A closed approach rhinoplasty including spreader grafting is a viable option in select cases with objective and validated functional improvement.

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“…Alar batten graft technique concentrates on improving the structural integrity of the internal nasal valve rather than increasing its crosssectional area. This is thought to be the key in treating this condition [17] .…”

Section: Discussionmentioning

confidence: 99%

Surgical Correction of Alar Collapse with Alar Batten Graft : Technique and Results

Saad

Taha

2017

EJHM

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Background: nasal valve collapse has great perception of nasal obstruction. The alar batten graft technique has proven to be a valid method for treatment of external and internal valve collapse. Aim: the aim of the present study was to evaluate a two year experience and follow up for external nasal valve collapse treatment using alar batten graft technique regarding results and complications. Patients and Methods: this prospective study was carried out on 18 patients attended the ENT and Plastic Surgery outpatient clinics of Al-Azhar University hospitals from January, 2014 to January 2016. Written consent was taken from every patient. All patients were complaining of nasal obstruction of gradual onset and progressive course with 7 years average. All patients were subjected to detailed history taking and questionnaire including the NOSE scale. Surgical correction was performed to all patients using the alar batten graft harvested from the septa cartilage or conchal cartilage. Postoperative results recorded in relation to subjective sensation of nasal obstruction and aesthetic appearance of the nose. Results: eleven patients (61.1%) were males and seven (38.9%) were females. Their age ranged from 18 to 45 years with a mean of 32±2. Bilateral obstruction was found in 33.3% of cases and unilateral obstruction in 66.7% of cases. There were 22.2%, 27.8%, and 50.0% of the cases had moderate, fair, and severe obstruction, respectively. Postoperatively, these figures were changed to no obstruction77.8% (P=0.0), mild 0.0%, moderate 11.1%, fair 11.1%, and sever 0.0%(P=0.0005). The technique significantly abolishes the severe nasal obstruction. Postoperative complications include 1 case with graft resorption (4.2%) and 1 case of graft displacement (4.2%). Both were improved on subsequent surgery. Regarding postoperative findings there was tenderness and hypertrophic postauricular scar in 5.5% of patient and nasal tip edema in 22.2%, all resolved. In the early postoperative period, 33.3% of patients complained of fullness in the supraalar region. Conclusion: Successful surgical correction of nasal obstruction requires the precise diagnosis of the anatomic point of collapse. Alar batten graft improves the rigidity of lower lateral cartilage preventing collapse of the lateral nasal wall preventing collapse during moderate and deep inspiration. The graft varies according to the severity of the obstruction and size of the collapsible area of the lateral nasal wall. The septal cartilage is usually sufficient. The technique significantly improves nasal breathing.

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Internal Nasal Valve Incompetence Is Effectively Treated Using Batten Graft Functional Rhinoplasty

Cited by 19 publications

References 12 publications

Midvault Reconstruction in Primary Rhinoplasty

Midvault Reconstruction in Primary Rhinoplasty

Assessment of Functional Rhinoplasty with Spreader Grafting Using Acoustic Rhinomanometry and Validated Outcome Measurements

Surgical Correction of Alar Collapse with Alar Batten Graft : Technique and Results

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