Nasal patency after open rhinoplasty with spreader grafts

Pochat, Victor Diniz de; Alonso, Nivaldo; Mendes, Rogério R.S.; Cunha, Marcelo Sacramento; Menezes, José V.L.

doi:10.1016/j.bjps.2011.11.059

Cited by 36 publications

(19 citation statements)

References 27 publications

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“…Demonstrating the effectiveness of functional rhinoplasty has received increasing at-tention in the literature. Earlier studies [14][15][16][17][18] reported on subjective and rhinometric improvement with spreader and alarbatten grafts in patients with NVI. Subsequent single-center studies [19][20][21][22] have also demonstrated improvement in patientreported outcomes using the validated NOSE scale.…”

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confidence: 99%

Outcome of Nasal Valve Obstruction After Functional and Aesthetic-Functional Rhinoplasty

Yeung

Hassouneh

Kim

2016

JAMA Facial Plast Surg

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INTRODUCTION Nasal valve insufficiency is distinct from other anatomic causes of nasal obstruction. Functional rhinoplasty refers to the collective techniques used to reconstruct the lateral nasal wall, typically achieved with the use of spreader and alar grafts. Patients undergoing functional rhinoplasty can also have aesthetic desires and goals achievable with combined aesthetic-functional rhinoplasty. OBJECTIVE To evaluate the improvement in nasal obstruction symptoms after cartilage graft reconstruction in patients with nasal valve insufficiency and to compare the postoperative improvement between patients undergoing functional and aesthetic-functional rhinoplasty. DESIGN, SETTING, AND PARTICIPANTS In this prospective multicenter cohort study, 12 participating surgeons enrolled 79 consecutive patients diagnosed as having nasal valve insufficiency as the primary cause of nasal obstruction. Patients underwent functional or aesthetic-functional rhinoplasty. The study collected demographic, clinical, and surgical data from March 2006 to September 2008. Nasal symptoms were evaluated using a validated, disease-specific, quality-of-life instrument. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to participants at baseline and 3, 6, and 12 months postoperatively. Follow-up was completed on September 2008, and data were analyzed in September 2009 and in September 2013. MAIN OUTCOMES AND MEASURES Changes in NOSE scale score (range, 0 to 100, with a higher score indicating greater severity of obstruction) at 3 months between the functional and aesthetic-functional groups. RESULTS Of the 79 patients, 31 underwent functional and 48 underwent aesthetic-functional rhinoplasty. Overall, an improvement was found in nasal breathing, with a mean decrease of 48.6 points (95% CI, 41.9-55.2; P < .001) at the 3-month assessment compared with the preoperative baseline NOSE scale score (mean [SD], 67.1 [19.7]). The improvement in nasal breathing was similar whether patients underwent functional or aesthetic-functional rhinoplasty (mean [95% CI] NOSE scale score change, 51.4 [42.1-60.7] and 46.6 [37.1-56.1], respectively; P = .49). CONCLUSIONS AND RELEVANCE Nasal valve reconstruction with spreader and alar grafts is effective in treating patients with nasal valve insufficiency. Combining aesthetic interventions with functional rhinoplasty did not seem to affect the magnitude of improvement in nasal breathing outcome. LEVEL OF EVIDENCE 2.

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confidence: 99%

Outcome of Nasal Valve Obstruction After Functional and Aesthetic-Functional Rhinoplasty

Yeung

Hassouneh

Kim

2016

JAMA Facial Plast Surg

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“…Acoustic rhinometry is a newer technique that is helpful in evaluating the cross-sectional area of the nose and localizing the site of obstruction. However, much debate still exists regarding the relative inconsistencies between subjective complaints of obstruction and objective measurements and readings [12].…”

Section: Resultsmentioning

confidence: 99%

The Role of a Diced Inverted Y Shaped Spreader Graft to Enhance Function in Open Rhinoplasty. A Novel Technique

Sherif

Kamel

2019

The Egyptian Journal of Plastic and Reconstructive Surgery

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The role of spreader grafts in open rhinoplasty is at times mandatory. Various studies have shown that spreader grafts mot only support nasal function by maintaining the nasal valve support, but also restore nasal dorsum aesthetics and camouflage minor dorsal nasal deviations. This study was aimed to evaluate a surgical modification of the spreader graft to augment the aesthetic and functional outcomes in open rhinoplasty.Patients and Methods: 24 patients (21 females, 3 males), who were candidates for open septo-rhinoplasty, were divided into two groups of 12 each. Group A traditional spreader grafts were applied, while in Group B, the modified diced inverted Y shaped spreader graft was used. Clinical assessments aided with photography were done at 3, 6 and 12 months postoperatively together with CT-scan (6 months), and subjective questionnaires to assess the aesthetic and functional end results. Results:The pre-and post-operative calculations made for the minimal cross sectional area at internal valve level using CT-scan showed there was mild significant changes in Group A more than the Group B (p-values=0.0010). In the Group A, there was an increase in the minimal cross sectional area at the level of the internal valve by more in Group A by +0.023cm 2 , while in Group B it was +0.019cm 2 , respectively.The patient satisfaction of the aesthetic results it was highest (86%) in Group A, but high (57%) in Group B. In addition, the procedure also clinically revealed a significant improvement in nasal obstruction in Group A (71%) and improvement in Group B (43%).Therefore, there was improvement of functional outcomes if spreader graft was used, with more aesthetic improvement if modified spreader graft is used.Conclucion: Modified spreader graft is an applicable, simple technical modification in spreader graft that could improve the aesthetic and functional outcomes in open septorhinoplasty.

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“…Moreover, the objective measurement of the precise extent of physical restrictions is limited in current clinical practice [4] [9]. In our experience, there is an inadequate correlation between rhinomanometry results and the patient's subjective symptoms.…”

Section: Discussionmentioning

confidence: 99%

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

Bessler¹,

Mende²,

Goubergrits³

et al. 2014

IJOHNS

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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.

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Nasal patency after open rhinoplasty with spreader grafts

Cited by 36 publications

References 27 publications

Outcome of Nasal Valve Obstruction After Functional and Aesthetic-Functional Rhinoplasty

Outcome of Nasal Valve Obstruction After Functional and Aesthetic-Functional Rhinoplasty

The Role of a Diced Inverted Y Shaped Spreader Graft to Enhance Function in Open Rhinoplasty. A Novel Technique

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

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