R009: Rhinoplasty: Improvement of the Internal Nasal Valve

Abstract

Problem addressed: preservation of internal nasal valve function in primary and secondary rhinoplasty. Methods and Measures: twenty-nine patients: 19 candidates to potential obstructive nasal problems after rhinoplasty (narrow nose, short nasal bones), and 10 with secondary rhinoplasty who underwent surgical correction by open and closed rhinoplasty, using flaring sutures of upper cartilages associated or nor to spreader grafts, between Dec 1, 2005 and July 1, 2006. Results: flaring sutures improved the cross sectional areas in rhinometry by 10% in patients with primary rhinoplasty and by 12% in secondary rhinoplasty. Spreaders grafts combined with flaring sutures by 18%. Mean nasal patency scores improved. Crosssectional areas were performed in 8 patients. Flaring sutures improved the cross sectional area in rhinometry by 10% in patients underwent primary rhinoplasty and 12% in the patients with previous nasal dysfunction. Spreader grafts combined with flaring sutures improved the cross sectional area by 18%. All patients answered the questionnaire NOSE and this results are shown in TABLE 1 and TABLE 2.The vast majority, 27 patients, (96%) experienced important improvement in their nasal airway. All patients have shown improvement on endoscopic view. (fig 1,2) No complications were noted. Cosmetic outcome was satisfactory in all 29 patients who also request cosmetic improvement. Results 1. Elwany S, Thabet H. Obstruction of nasal valve. J Laryngol Otol 1996; 110:221-224. 2. Khosh MM, Jen A, Honrado C, et al. Nasal valve reconstruction: experience in 53 consecutive patients. Arch Facial Plast Surg 2004; 6:167-171. 3. Gola R. Functional and esthetic rhinoplasty. Aesthetic Plast Surg 2003; 27:390-396. 4. Constantinidis J, Daniilidis J. Aesthetic and functional rhinoplasy. Hosp Med 2005; 66:221-226 5. Schlosser RJ, Park SS. Surgery for Dysfunctional Nasal Valve. Arch Facial Plast Surg 1999; 1: 105-108. 6. Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) Scale. Otolaryng, Head And Neck surgery 2004; 157-162. Bibliography Twenty-nine ( 29) patients included (22 women and 7 men: median age 35 years; age range, 2060) In 21 patients who underwent an open approach, and 8 patients who underwent the closed approach, the flaring sutures of upper cartilages was performed associated to spreader grafts in 19 patients and used alone in 10.5 Nineteen patients with potential obstructive nasal problems (short nasal bone, narrow nose) and ten patients with valve dysfunction who had undergone previous rhinoplasty were rated preoperative and postoperative nasal patency on a questionnaire based on a scale NOSE – Nasal Obstructive Symptoms Evaluation ( table I and II )6. The population for this study who underwent to rhinometry was limited to individuals with severe nasal obstruction. (8). Patients underwent clinical review and from six months to 12 months after surgery. Methods and Materials Figure 2 The simplicity of the flaring suture of upper lateral cartilages along with its potential to minimize the risk of internal valve disturbance, especially for noses with a high and narrow roof, justifies, the use of this suture in our experience. This is a valuable addiction to the armamentarium of the rhinoplasty: great aesthetic and functional outcome can be achieved. Conclusions Introduction Nasal valve dysfunction remains prevalent among many etiologies for airway obstruction, which may be post traumatic, idiopathic, congenital, and result of prior rhinoplasties 1,2 . This problem has a role in up to 13 % of adults complaining of chronic nasal obstruction.1 and yet this anatomical and dynamic factor has been overlooked by many otolaryngologysts. The current trend in rhinoplasty is to minimize surgical resection to avoid postoperative valve dysfunction. 3,4 Figure 1 25,0 Postoperative 50,0 Preoperative Score Time of test Table 1 31,0 Postoperative 70,0 Preoperative Score Time of test Table 2 Prolene flaring suture Prolene flaring suture