Treatment of Internal Nasal Valve Collapse with Radiesse (CaHA) Injection Spreader Grafting

Abstract

Introduction: Nasal obstruction secondary to internal nasal valve (INV) collapse is a well-described condition. Symptoms of INV collapse include chronic nasal congestion, nasal airway obstruction, snoring, and difficulty obtaining restful sleep. The authors report the use of calcium hydroxylapatite (CaHA) injection as a spreader graft to improve nasal airway patency in patients experiencing INV collapse. Materials and Methods: Of 12 patients enrolled in the study, 6 patients completed follow-up and are the subject of this report. They were evaluated and found to have bilateral INV collapse resulting in nasal obstruction. A total of 12 sides were injected with small aliquots of CaHA, also known as Radiesse. Injections were directed into the INV at the junction of the upper lateral cartilage and the dorsal septum until nasal obstruction was relieved and INV angles were visually increased. Biopsy of the CaHA spreader graft was undertaken for histologic evaluation in 1 patient who underwent elective cosmetic rhinoplasty. Each patient completed subjective nasal airway patency questionnaires documenting their degree of perceived nasal obstruction before the CaHA spreader graft and at the 3-month follow-up. Results: All 6 patients experienced immediate subjective relief of their nasal obstruction with the CaHA spreader graft. Immediate posttreatment INV angles were visually widened at rest and during inspiration. At the 3-month follow-up, the improvement in the INV angles remained for all 6 patients. In addition, the subjective nasal airway patency evaluations universally correlated with the observed changes, and high patient satisfaction was preserved. Histologic findings for 1 patient revealed fibrous tissue with few foreign body giant cells. Discussion: Use of CaHA spreader graft injection to relieve nasal obstruction because of INV collapse appears to be a reasonable nonsurgical alternative. Long-term studies are ongoing.