Pyriform Widening with Concurrent Z-Plasty for Nasal Valve Surgery: Revisiting a Time-Tested Technique

Abstract

Introduction: Nasal obstruction may originate from the nasal valve. Many surgical techniques to improve the nasal valve are available but may fail to correct obstruction originating from a narrow pyriform aperture. We present a technique to widen the narrow pyriform aperture and review the literature. Materials and Methods: The article highlights a retrospective case series of patients who underwent pyriform widening with concurrent Z-plasty (PWZ) for nasal obstruction. Subjective measures of nasal obstruction were analyzed using the Nasal Obstruction Symptom Evaluation (NOSE) scale. The procedure consists of an incision made anterior to the inferior turbinate along the inferior aspect of the lateral bony pyriform. The periosteum is elevated, and a rongeur is used to widen the exposed bone. After oblique incisions are made, soft tissue flaps are elevated and transposed. The literature is reviewed. Results: Six adults underwent PWZ for nasal obstruction from 2011 through 2014. Three patients had prior nasal surgery. All patients reported subjective improvement, with mean NOSE scale scores of 15.7 preoperatively and 9.7 postoperatively. In the literature, all prior articles on pyriform aperture widening report positive outcomes. Conclusions: The surgical correction of nasal obstruction is challenging, given the complexity of the nasal valve. Upon review of the literature and analysis of our experience, we advocate consideration of PWZ in patients with anatomic obstruction at the level of the pyriform rim who have failed previous procedures or as an adjunct to primary nasal valve surgery. Further research is needed to examine the effects of pyriform widening on nasal obstruction.