Comprehensive Repair of the Nasal Valve in the Management of Obstructive Sleep Apnea

Abstract

Objectives: To analyze whether the nasal valve cartilage repositioning procedure described here results in a significant improvement in patients with obstructive sleep apnea (OSA). Methods: This is a prospective case series conducted at a university public hospital from 2011 to 2014. Adult patients who had OSA, nasal obstruction with valve collapse, and body mass index less than 30 were included in the study. All patients had a cartilage repositioning L-strut septoplasty via full transfixion incision. Specifically, the septal dorsum is exposed, released from the upper lateral cartilages and bony septum, and repositioned in the midline and fixated to the nasal spine, thus restoring the L-strut position. In addition, the nasal sidewalls were repaired using the Alar™ endonasal stent device to reposition the upper lateral and lower lateral cartilage after release into positions of increased overlap, thus increasing the diameter of the nasal valve. Preoperative and postoperative (3 months) polysomnograms were obtained. Statistical analysis using the paired t-test was used to determine significance. Results: Fifteen patients were included in this study. Average apnea-hypopnea index (AHI) scores preoperatively were 24. Postoperative AHI scores averaged to 13, a reduction of 54% ( P = .04). Only 3 out of 15 patients showed no improvement. Conclusions: The comprehensive repair of the nasal valve including repair of the nasal sidewalls and septal L-strut can significantly improve the severity of OSA for select patients. This is a fast and minimally invasive approach to consider in patients with OSA and nasal valve collapse.