Surgical techniques for the treatment of nasal valve collapse: a systematic review

Abstract

Objectives. To critically evaluate the surgical treatment strategies for nasal valve collapse and their outcomes.Method. A systematic review of studies for surgically treated nasal valve collapse from 1970 to 2006 including an analysis of techniques and their outcomes. Database search of EBM reviews, (Cochrane, DARE, CCTR & ACP Journal club), Medline and EMBASE’ including a hand search of bibliographies in identified papers. The outcomes used are success of techniques at relieving symptoms and cosmesis. The inclusion criteria was a minimum of 10 patients in each study with a defined minimum 6‐month period of follow‐up.Results. No randomised trials exist; 31 studies met the minimal inclusion criteria. Seventeen addressed the internal nasal valve, seven the external nasal valve and seven both. A variety of techniques have been used including spreader grafts, alar batten grafts, splay grafts, butterfly grafts, and lateral expansion sutures. All techniques have high success rates with no single technique appearing more successful than others. Studies had similar inclusion criteria and a mean follow up >12 months. The level of evidence is III. Few studies provided objective measures of nasal airflow in the form of rhinomanometry, but when presented results were significantly improved.Conclusions. A variety of surgical techniques are available to deal with nasal valve collapse. The specific pathological problem causing obstruction at the nasal valve must be identified and the surgical solution tailored to the individual. There is no ‘one size fits all’ procedure.