Reconstruction of the Internal Nasal Valve with a Splay Conchal Graft

Abstract

The internal nasal valve is the narrowest point in the nasal airway and thus is the controlling point that regulates inspiration flow. The cross-sectional area of the internal nasal valve is approximately 40 to 55 mm, and 40 to 50 percent of inspiratory resistance is attributable to internal nasal valve function. Collapse of one or both internal nasal valves can be a consequence of previous surgery, trauma, aging, or primary weakness of the upper lateral cartilage. In this study, autologous conchal cartilage was used as a splay graft for opening and reconstructing the internal nasal valve. Over 3.5 years, 31 patients (18 female patients and 13 male patients) were operated on using the splay graft. Inclusion criteria were positive Cottle sign and modified Cottle sign. Cause of collapse was previous surgery in 12 patients (38.7 percent), primary weakness in 10 patients (32.3 percent), and nasal trauma in nine patients (29 percent). After 10 to 42 months of follow-up, 80.6 percent of patients had good to excellent (stable) subjective respiratory function. There was no major morbidity or complication after surgery. Six patients complained of broadening in the middle nasal vault.

Reliability and construct validity of the Ottawa valve collapse scale when assessing external nasal valve collapse

“…The Cottle Maneuver is the most commonly used test to diagnose clinically relevant nasal valve competency requiring surgical correction [ 2 , 12 ]. Despite its widespread use, to our knowledge it has never been validated using patient centered outcomes, nor has it been confirmed to be a reliable test [ 16 – 18 ]. Additionally, the test only allows for a dichotomous assessment and does not provide information on valve collapse severity nor does it differentiate between external and internal valve collapse.…”

Axial computed tomography evaluation of the internal nasal valve correlates with clinical valve narrowing and patient complaint

“…However, it is generally considered nonspecific and does not differentiate between internal and external valve disorders. The modified Cottle test uses a cotton tip applicator within the nose to elevate and displace the lateral nasal wall and upper lateral cartilage . This method of testing in combination with the traditional Cottle maneuver can help distinguish the responsible valve, but it is important not to confound the examination by exerting excessive pressure.…”

The value of spreader grafts in rhinoplasty: a critical review

“…Spreader grafts are usually linear strips of autologous cartilages, which may be harvested from the septal cartilage, aural (conchal) cartilage, or rib cartilage [24]. Other materials which have been used as spreader grafts are hyaluronic acid (Restylane ® ) [25], calcium hydroxylapatite (Radiesse ® ) [26], high-density porous polyethylene (Medpor ® ) [27, 28], and polymer of polylactic and polyglycolic acid (Lactosorb ® ) [29].…”