Surgical techniques for the treatment of nasal valve collapse

Spielmann, Patrick; White, Paul S.; Hussain, S. S. M.

doi:10.1002/lary.20495

Cited by 107 publications

(37 citation statements)

References 47 publications

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“…Similar findings and conclusions were presented in another systematic review by Spielman et al 10 The review reported that nasal valve surgery research is too focused on the technique rather than patient outcomes. Additionally, the review pointed out the deficiencies in the use of objective measures for assessing nasal airflow to evaluate the efficacy of treatment.…”

Section: Discussionsupporting

confidence: 84%

Clinical consensus statement: Diagnosis and management of nasal valve compromise

Rhee

Weaver

Park

et al. 2010

Otolaryngol.--head neck surg.

176

239

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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.

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Section: Discussionsupporting

confidence: 84%

Clinical consensus statement: Diagnosis and management of nasal valve compromise

Rhee

Weaver

Park

et al. 2010

Otolaryngol.--head neck surg.

176

239

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show abstract

“…The nasal valves have been proposed to be a major regulator of nasal airflow, causing resistance and preventing airflow from exceeding the capacity to warm and humidify inspired air [2, 3]. The external nasal valve describes an area of the nasal vestibule bounded by the alar rim, nasal sill, and caudal septum [4, 5].…”

Section: Introductionmentioning

confidence: 99%

“…Some commonly used procedures include batten grafts for external valve collapse and spreader grafts for internal valve compromise; other techniques include butterfly onlay grafts, alar rim grafts, suture suspension, and flaring sutures [2–10]. Accurate preoperative diagnosis of the specific anatomic problem and subsequent selection of the appropriate surgical technique will ensure the best possible results for patients undergoing functional rhinoplasty.…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Modified Cottle Maneuver in Predicting Outcomes in Functional Rhinoplasty

Fung

Hong

Moore

et al. 2014

Plastic Surgery International

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Objective. To assess the outcomes of functional rhinoplasty for nasal valve incompetence and to evaluate an in-office test used to select appropriate surgical techniques. Methods. Patients with nasal obstruction due to nasal valve incompetence were enrolled. The modified Cottle maneuver was used to assess the internal and external nasal valves to help select the appropriate surgical method. The rhinoplasty outcomes evaluation (ROE) form and a 10-point visual analog scale (VAS) of nasal breathing were used to compare preoperative and postoperative symptoms. Results. Forty-nine patients underwent functional rhinoplasty evaluation. Of those, 35 isolated batten or spreader grafts were inserted without additional procedures. Overall mean ROE score increased significantly (P < 0.0001) from 41.9 ± 2.4 to 81.7 ± 2.5 after surgery. Subjective improvement in nasal breathing was also observed with the VAS (mean improvement of 4.5 (95% CI 3.8–5.2) from baseline (P = 0.000)). Spearman rank correlation between predicted outcomes using the modified Cottle maneuver and postoperative outcomes was strong for the internal nasal valve (Rho = 0.80; P = 0.0029) and moderate for the external nasal valve (Rho = 0.50; P = 0.013). Conclusion. Functional rhinoplasty improved subjective nasal airflow in our population. The modified Cottle maneuver was effective in predicting positive surgical outcomes.

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“…Further INVI surgery is often performed by several surgeons within an institution [11]. This case series adds valuable data to previously published work [5] and is one of the only case series performed by one operating surgeon. This provides consistency in technique unlike other series published.…”

Section: Discussionmentioning

confidence: 91%

“…Series are usually small [3] and involve several operating surgeons [4] without specific outcomes. Recent papers have called for a single technique by a single operating surgeon to be assessed [5]. …”

Section: Introductionmentioning

confidence: 99%

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

Bewick

Buchanan

Frosh

2013

International Journal of Otolaryngology

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Introduction. Internal nasal valve incompetence (INVI) has been treated with various surgical methods. Large, single surgeon case series are lacking, meaning that the evidence supporting a particular technique has been deficient. We present a case series using alar batten grafts to reconstruct the internal nasal valve, all performed by the senior author. Methods. Over a 7-year period, 107 patients with nasal obstruction caused by INVI underwent alar batten grafting. Preoperative assessment included the use of nasal strips to evaluate symptom improvement. Visual analogue scale (VAS) assessment of nasal blockage (NB) and quality of life (QOL) both pre- and postoperatively were performed and analysed with the Wilcoxon signed rank test. Results. Sixty-seven patients responded to both pre- and postoperative questionnaires. Ninety-one percent reported an improvement in NB and 88% an improvement in QOL. The greatest improvement was seen at 6 months (median VAS 15 mm and 88 mm resp., with a P value of <0.05 for both). Nasal strips were used preoperatively and are a useful tool in predicting patient operative success in both NB and QOL (odds ratio 2.15 and 2.58, resp.). Conclusions. Alar batten graft insertion as a single technique is a valid technique in treating INVI and produces good outcomes.

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Surgical techniques for the treatment of nasal valve collapse

Cited by 107 publications

References 47 publications

Clinical consensus statement: Diagnosis and management of nasal valve compromise

Clinical consensus statement: Diagnosis and management of nasal valve compromise

The Effectiveness of Modified Cottle Maneuver in Predicting Outcomes in Functional Rhinoplasty

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

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