Abstract
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.
Highlights
Chronic nasal obstruction can be quite distressing and often has a negative impact on quality of life [1]
It is crucial that the anatomic areas involving the external and internal nasal valves are evaluated diligently in the preoperative setting to identify the specific area of obstruction
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]
Summary
Chronic nasal obstruction can be quite distressing and often has a negative impact on quality of life [1]. The internal nasal valve is bounded medially by the nasal septum, superiorly and laterally by the caudal margin of the upper lateral cartilage, and more laterally by the anterior portion of the inferior nasal turbinate [4, 6]. Many underlying static and dynamic factors can contribute to the obstruction of the nasal valves, including trauma, previous surgery or radiation, congenital weakness of the nasal cartilage, or aging [1, 4]. The Bernoulli principle states that air flowing through a narrow segment accelerates, leading to a decrease in intraluminal pressure [4]. This phenomenon is demonstrated by the collapse of the lateral nasal wall, during deep inspiration. Obstruction of the nasal valves may result from varying degrees of static obstruction and dynamic collapse
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