External Nasal Valve Research Articles

The Assessment of External Nasal Valve Efficiency After Le Fort I Surgery: Erratum.

The Assessment of External Nasal Valve Efficiency After Le Fort I Surgery: Erratum.

Five-blade scratcher for treating severe rhinophyma: A retrospective study.

Rhinophyma, a late-stage subtype of rosacea, is characterized by excessive sebaceous glands and connective tissue proliferation. Patients may experience respiratory disturbances and psychological distress that significantly affect their quality of life when excessive nasal hyperplasia obstructs the external nasal valves. Surgery is the treatment of choice for rhinophyma. However, excessive bleeding, scarring, pigmentation, and high recurrence rates frequently characterize current surgical methods. To evaluate the clinical effectiveness and recurrence rates after treating severe rhinophyma with the five-blade scratcher. This study retrospectively analyzed the clinical records of 28 patients with severe rhinophyma rosacea. The Global Flushing Severity Score (GFSS), Clinician Erythema Assessment (CEA), Rhinophyma Severity Index (RHISI), Glasgow Benefit Inventory (GBI), and satisfaction scores were used to assess the recovery of patients at 6 months and 5 years, with the recurrence rate calculated at 5 years postoperatively. In addition, the levels of pro-inflammatory factors (TNF-α, IL-1β, and IL-6) in the serum of patients before and after surgery were detected by ELISA. The GFSS, CEA, and RHISI scores at 6 months and 5 years postoperatively were significantly lower than those preoperatively (P < 0.001 for both periods). Five-blade scratcher treatment greatly benefits patients as demonstrated by the GBI and patient satisfaction. A small number of patients (7/28, 25%) reported recurrence after surgical treatment for rhinophyma in our department that was not more serious than before treatment. The expression of pro-inflammatory factors (TNF-α, IL-1β, and IL-6) in the patient's serum was significantly reduced after surgery of five-blade scratcher. The five-blade scratcher treatment demonstrates notable advantages, including simplicity, safety, efficacy, and cost-effectiveness, coupled with reduced bleeding, minimized scarring, lower recurrence rates, reduced the level of pro-inflammatory factors and improved patient satisfaction. Consequently, this therapeutic modality exhibits a viable option for individuals afflicted with severe rhinophyma.

The Alar Extension Graft Technique for the Treatment of External Nasal Valve Collapse: Preliminary Results of a Single-Centre Prospective Analysis.

The aim of this study is to describe the efficacy of the alar extension graft for the correction of external nasal valve collapse and to evaluate the functional and aesthetic results. The study included 51 patients who underwent alar extension grafting for external nasal valve collapse. Pre- and post-operative rhinomanometry was performed before and after surgery. NOSE and SNOT 20 questionnaires were completed before and 9 months after surgery. Patients were also asked about their post-operative satisfaction. 90% of patients were subjectively satisfied with the post-operative improvement in nasal breathing. There was a significant improvement in the values of the pre- and post-operative NOSE and SNOT 20 questionnaire scores. Rhinomanometry showed increased nasal flow with a statistically significant difference between pre- and post-operative results. The alar extension graft has been proved to be effective and reliable in the surgical treatment of external nasal valve collapse, improving the patients' objective and subjective breathing with good functional and aesthetic results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Management of Nasal Valve Dysfunction.

Nasal valve dysfunction can substantially impact nasal airflow and overall quality of life. This review provides a comprehensive examination of nasal valve dysfunction, including its mechanisms, classification, and surgical management. The nasal valves include internal and external valves, each of which plays a crucial role in regulating nasal airflow. Subclassification of the external nasal valve into alar and rim valves helps specify the site of obstruction when present and informs the choice of surgical intervention. Dynamic nasal valve obstruction, often characterized by inspiratory collapse of the nasal valve, must be distinguished from static obstruction, which refers to nasal valve stenosis. Accurate identification of the location and mechanism of nasal valve dysfunction is essential for effective management. Various surgical procedures target specific components of the nasal valve and can produce favorable functional outcomes. The selection of surgical procedures, whether individually or in combination, should be tailored to the characteristics of nasal valve dysfunction and the external nasal characteristics of the patient. Strict adherence to proper surgical techniques is imperative for achieving optimal treatment outcomes.

"Supratip Cross Flap: Reshaping the Nasal Tip and Improving the Nasal Vault Function."

The authors propose a novel flap for rhinoplasty: the supratip cross flap (SCF). It is a simple and effective method for avoiding and correcting alar contour deformities and external nasal valve (ENV) issues in rhinoplasty without grafts. In addition to its benefit for supratip break, the flap also allows a smooth and natural transition between the nasal dorsum and the nasal tip complex.

Radiographic Study of the Nasal Valve in Different CT Evaluation Method in Asian Patients with Unilateral Cleft Lip Nose.

It was the first study to apply and compare two CT methods to assess the validity and clinical significance of structural alterations of the nasal valve in patients with cleft lip nose for assessing nasal ventilation disturbance. The study collected data from the NOSE score, as well as internal nasal valve area, internal nasal valve angle, external nasal valve area, and septal deviation angle, to evaluate the differences and correlations between those factors in patients with cleft lip and nose. There were significant differences among INV transverse and coronal area and INV angle on different axial standardized planes between clefted side and non-clefted side. There were statistically significant negative correlations between NOSE scores and those indicators of standard plane and acoustic-axis standardized coronal plane. NOSE score and NSD angle were the indicators of significant differences in the measured data of different complications groups (p = 0.002, p = 0.017). The correlation comparison showed that two standardized CT imaging transverse planes have similar correlations in NOSE score, NSD angle, and complications. The results of the two CT evaluation methods showed that there was a significant difference in nasal valve area on the cleft and non-cleft sides, which was significantly associated with nasal ventilation disturbance. The CT evaluation method based on standard axial 3D reconstruction is more convenient to use in the clinic, can be used for pre-surgical evaluation of nasal repair in patients with secondary nasal deformities of unilateral cleft lip, and is valuable for treatment. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Süreyya-Dani technique, a new technique to address notching of soft triangle and opening external nasal valve.

While different methods are employed for fixing narrowed nasal valves and preventing the notching of soft triangles, this study aims to demonstrate the effectiveness of a new technique called Süreyya-Dani Technique. This prospective study composed 100 patients who underwent rhinoplasty using the Süreyya-Dani technique. All patients presented with either notching of the soft triangle and/or external nasal valve dysfunction. Patients with the absence of soft triangle notching and external nasal valve dysfunction were excluded from this study. Facial analysis was conducted for all patients to identify any asymmetry in the face, and all nasal defects were identified. Descriptive statistics were calculated for different variables. Analytical statistics, namely Chi-Square test, was conducted with a significance level set at P < 0.05. In the current study, 100 patients were involved, out of which 63 (63%) were female and 37 (37%) were male. The participants' ages ranged from 18 to 46 years, with a mean age of 30 years. various chief complaints were found among patients, with the majority 37(37%) expressing cosmetic concerns. A statistically significant difference was found for the association of nasal tip defects with genders, intraoperative findings, and chef complaints, and the association between the degree of external valve insufficiency and crural weakness (P-value < 0.05). Despite many techniques that have been put forward to fix narrowed nasal valves and prevent notching of the soft triangle, the Süreyya-Dani Technique could work to prevent its occurrence successfully.

Management of Lateral Wall Insufficiency.

Lateral wall insufficiency is a commonly encountered etiology of nasal obstruction, resulting from dynamic collapse at the level of the internal or external nasal valve. Various management strategies exist to strengthen the lateral wall or stent the nasal valves to relieve nasal obstruction, and range from noninvasive devices, minimally invasive implants, or surgical reconstructive techniques. Surgical options to address the nasal valves are selected based on each patient's anatomic findings, aesthetic and functional goals, and surgeon preference. This article describes the anatomy and physiology of the nasal sidewall and nasal valves and diagnosis of lateral wall insufficiency, and provides a framework for treatment options.

The Assessment of External Nasal Valve Efficiency After Le Fort I Surgery.

The present study investigated how external nasal valve function is affected after Le Fort I osteotomy using external nasal valve efficiency (ENVE) index. Twenty-one patients who underwent Le Fort I osteotomy with or without mandibular osteotomy were included in the retrospective study. Preoperative and postoperative standardized videos of basal view of the nose during breathing were recorded, and 2 screenshots were taken, 1 in the resting position and the other after deep inspiration. External nasal valve efficiency was calculated at preoperative and postoperative periods for each patient. Of the 21 patients, 12 were women and 9 were men (mean age, 26.63 ± 8.20 years). The mean ENVE index was 0.75 ± 0.16 for the preoperative period and 0.82 ± 0.17 for the postoperative period. There was a significant difference between these values ( P = 0.002). When the correlation of the ENVE with maxillary movements was analyzed, the ENVE was negatively affected by maxillary impaction ( P = 0.011, r = -0.540). These findings imply that Le Fort I osteotomy positively affects the ENVE index. However, because of the antagonistic relation between maxillary impaction and ENVE, higher maxillary impaction amounts or isolated maxillary impaction should be carefully planned in patients with low ENVE index.

Functional nasal surgery in the office-based setting.

Nasal obstruction is a very common problem often addressed by functional nasal surgery. Increasingly, these procedures are being performed in the office setting secondary to decreased down time, cost, and obviation of general anesthesia. Our goal with this review is to discuss how to appropriately select patients for office-based procedures, what procedures may be considered, and current outcomes with in-office functional nasal surgery. PubMed, Scopus, Google Scholar. Research databases were searched for articles discussing techniques for performing functional nasal surgery in an office setting, and outcomes of various in-office functional nasal procedures. Studies found and included in this review discuss many aspects of office-based functional nasal surgery, including practical points on patient selection and office set-up, what procedures can safely be performed, and outcomes of different techniques to address specific problems. Broadly, procedures amenable to performance in the office address the internal and external nasal valves, the nasal septum, and the inferior turbinates. A wide range of techniques to aaddress the nasal valves, septum, and inferior turbinates can be performed in a safe and effective manner without the need for an operative suite.

The Comprehensive Evaluation of the Pinch Deformity due to Concave Alar Cartilages and Its Management.

Acute angle between dome and ala causes alar concavity/pinch deformity. Breathing problems may accompany pinching. Here, pinch deformities were classified according to their severity and treatment modalities discussed. Rhinoplasty patients with pinch deformities were included in study. Pinching without external nasal valve blockage (ENVB) was classified mild, pinching with ENVB was classified moderate, and extreme pinching and ENVB were classified severe deformity. In mild deformity, cephalic resection of ala was performed or cephalic resection was combined with onlay graft over ala. In moderate deformity, cephalic part was bent and sutured over lower ala. In severe deformity, cephalic part was bent, and lateral strut graft was inserted between lower and cephalic ala. In pinch deformities combined with hypertrophic lower lateral cartilage (LLC), medial crural overlay preceded above-mentioned treatment modalities. Thirty-eight patients (22 female, 16 male) with pinch deformities underwent rhinoplasty between January 2017 and December 2022. Mean age was 27 years. Mean follow-up was 32 months. Fifteen patients had mild deformities. Cephalic resection was enough in four patients. Camouflage grafts were settled over ala in eleven patients. Twenty patients had moderate deformities; cephalic ala was bent over lower part and sutured. Two patients had severe deformities; lateral strut graft was settled between lower and bent cephalic alar parts. One patient had LLC hypertrophy/pinch deformity. LLC hypertrophy was corrected by medial crural overlay, and concavity was corrected with cephalic resection. Satisfactory shape, better valve passage obtained in all cases. Pinch deformity could be classified according to its severity and appropriate treatment options could be determined for each class. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/journal/00266 .

Surgical correction of the lower lateral cartilage protrusion and external nasal valve pinching with lateral crural resection technique

ObjectiveThe aim of this study is to demonstrate a novel surgical technique in the treatment of lower lateral crural protrusion and external nasal valve pinching. MethodThe lower lateral crural resection technique was used in 24 patients who underwent open technique septorhinoplasty between 2019 and 2022. Fourteen of the patients were female and 10 were male. In this technique, excess part of crura's tail was excised from the lower lateral crura and placed in the same pocket. This area was supported with a diced cartilage and a postoperative nasal retainer was applied. We have corrected the aesthetic problem that occurs when the lower lateral cartilage is convex, and external nasal valve pinching that occurs when the lower lateral crural protrusion is concave. ResultThe mean age of the patients was 23. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery. ConclusionA new surgical approach has been proposed for patients with lower lateral crural protrusion and external nasal valve pinching using the lateral crural resection technique.

Significance of Internal Nasal Valve and Nasal Septal Swell Body in Improving the Outcome of Septoplasty: A Literature Review

Nasal obstruction is a common presenting symptom for both primary care physicians and otolaryngologists, and it can be caused by various anatomic, physiologic, and pathophysiologic factors. Structural nasal obstruction may result from a Deviated Nasal Septum (DNS), Internal Nasal Valve (INV) obstruction, External Nasal Valve (ENV) obstruction, inferior turbinate hypertrophy, Nasal Septal Swell Body (NSB) etc. Combined causes occasionally go unnoticed, and postoperative symptom relief may not always be satisfactory. Revision surgeries in cases where septoplasty fails due to misdiagnosed multicausative factors can increase the complexity of the procedure, further affecting its success. In this review, our objective is to examine the significance of the NSB and the INV, which are often overlooked nasal structures, in improving the outcomes of septoplasty. Upon reviewing the findings, it can be confirmed that diagnosing these overlooked structures has led to improved outcomes in septoplasty and, consequently, the quality of life for patients with nasal obstruction.

Description of a Novel Technique to Address Both External Nasal Valve Collapse and the Aesthetic of the Nasal Tip.

Severe concavity of the lateral crura can lead to an unsightly aesthetic deformity of the nasal tip and narrowing of the external nasal valve. Concurrently, if the lateral crura are structurally weak, this can lead to a functional issue. We report a previously undescribed technique of combining a lateral crural reversal with a turn-in flap. This achieves dual goals of aesthetic improvement and structural reinforcement, without the need for grafting.

Titanium Implants in the Nose: State of the Art.

Titanium implants in the head have been used widely for decades. Dental implants as well as titanium plates, screws, and mesh have been an integral part of dental and maxillofacial surgery. In the nose, titanium implants were started in 2003. Their purpose is to increase structure and stiffness to nasal cartilages widening the airway. This overview describes the use of titanium implants in the various locations in the nose. We concentrate on three locations: Breathe Implants on the upper lateral cartilage to widen the internal nasal valve, modified breathe implants in the lower lateral nasal wall fixed to the piriform aperture as batten grafts to widen the external nasal valve, and flattened breathe implants as titanium septum plates to straighten and strengthen the nasal septum.

33959 Novel nasal alar reconstruction with hyaluronic acid after Mohs micrographic surgery and repair

Mohs micrographic surgery (MMS) has become a treatment of choice for certain nonmelanoma skin cancer, especially when lesions are located on aesthetically sensitive areas of the body such as the face. Due to the unique anatomy of the nose, reconstruction of nasal defects following MMS can present a challenge. Surgery to certain nasal structures, such as the ala, columella, or tip, can result in external nasal valve collapse. Reduction in the radius of the nasal valve areas by even a small amount can cause significant effect on nasal airflow and nasal resistance. Several methods may be employed for prevention or correction of nasal defects following MMS. For example, use of cartilage grafting has shown good results in maintaining nasal ala structure and reducing the risk of alar collapse. Furthermore, various suture techniques have been described that may be used intraoperatively to try to prevent alar collapse, including a 3-point suture and a suspension suture technique. In terms of postoperative correction, conservative measures are often used first. For instance, treatment of increased flap bulk causing compression may be done with steroid injection. If this should fail, flap debulking may become necessary to correct the issue. In cases of substantial external valve collapse, batten grafting has been used to repair the defect and improve inspiratory airflow. Here we present cosmetic filler as a novel method for treatment of nasal alar collapse in patients who may not wish to undergo surgical correction.

Functional Nasal Surgery.

After studying this article, the participant should be able to: (1) understand the functional significance of nasal anatomy as it relates to rhinoplasty and perform a comprehensive functional nasal assessment. (2) Identify the anatomical level of obstruction based on the authors' algorithmic approach and understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, external nasal valve collapse. (3) Understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, and external nasal valve collapse. (4) Appreciate the objective assessment tools for functional nasal surgery from a clinical and research perspective. The intent of functional rhinoplasty is to improve nasal airflow (and the perception thereof) by surgically correcting the anatomical sources of obstruction in the nasal airway. Cosmetic and functional rhinoplasty are not mutually exclusive entities, and the techniques that address one area, inevitably may affect the another. The rate of functional problems after cosmetic rhinoplasty range from 15 to 68 percent with nasal airway obstruction found to be the most common indication for secondary surgery. The objective of this CME article is to provide readers with an understanding of the (1) functional components of nasal anatomy, (2) clinical functional assessment, and (3) the current evidence supporting corrective maneuvers for each component.

Reorienting Lower Lateral Cartilages With Lateral Crural Struts: Aesthetic and Functional Benefits

Nasal tip shape and position play a major role in the aesthetic appearance of the nose. Cephalically oriented lower lateral cartilages (LLC) are associated with a broad boxy nasal tip. Reorienting cephalically positioned LLC with lateral crural strut grafts is a technique used to correct the nasal tip. An open approach surgical technique is described to evaluate the true orientation of the LLC and correct the boxy nasal tip. Five cases are shown with pre- and post-op pictures. The identical surgical technique is used in all cases with a variation in grafts necessary to create the desired esthetic result. All 5 described cases are on female patients. In all cases, reorientation of the lateral crura with lateral crural strut grafts were performed. In all, 4 of the 5 cases required a columellar strut graft, 3 cases required a shield graft to increase nasal tip projection and control the columellar-lobular angle, and 2 cases required spreader grafts for internal nasal valve support. All 5 cases required a variation of inter and intra-domal suture techniques to refine the nasal tip. A boxy nasal tip with supra-tip fullness is commonly associated with cephalically oriented LLC. Changing the orientation of the LLC to a more favorable angle and using lateral crural strut grafts can be used to not only correct the nasal tip deformity, but also facilitate projecting/de-projecting the nose, changing the rotation of the tip, and also supporting the external nasal valve. Reorienting cephalically oriented LLC is a versatile approach to reshaping the nasal tip. It is a technically demanding maneuver that when executed, allows complete control of the nasal tip complex. We have used this approach in many cases involving a boxy nasal tip with long ptotic tips and poorly supported external valves.

Surgical Treatment of Dynamic Nasal Collapse.

Nasal obstruction is a prevalent issue that significantly impacts patient quality of life and contributes to a large-scale financial burden. Internal or external nasal valve collapse may play a role in nasal obstruction, with varying etiologies. Surgical correction of nasal valve collapse is indicated when septal and/or turbinate surgery alone are not sufficient in correcting the nasal obstruction. The choice of how to address nasal valve repair depends on presenting findings, associated aesthetic concerns, particularly of the nasal tip, patient anatomy, and surgeon preference. This article provides a methodical approach to the diagnosis of nasal valve collapse, indications for repair, and provides detailed explanation of the operative techniques used to address nasal valve collapse, while also discussing the advantages and disadvantages of each approach.

Inferiorly Based Alar Groove Flap for Correction of Alar Base Malposition and Nasal Stenosis.

Summary:When the external nasal valve (ENV) is excessively narrow or lacks support, nasal obstruction can develop causing decreased airflow. Although cartilage grafts may support a collapsed nasal ala, addressing severe nasal stenosis requires further intervention. Techniques to move flared ala inward are well-known; however, repositioning a medially displaced alar base is less commonly described. Our surgical team developed an inferiorly based alar groove flap to achieve lateral movement of a malpositioned alar base, with goals of widening the ENV and improving nasal symmetry and cosmesis. A retrospective chart review was performed on a series of five patients over a two-year period. Charts were reviewed for demographic data, medical and surgical history, functional airway complaints, and subjective aesthetic concerns. All patients presented with unilateral ENV collapse, alar base malposition, and nostril asymmetry. Our operative method consisted of repositioning the affected alar base laterally and inferiorly to alleviate nostril stenosis and using an alar rim graft to support the ENV. Postoperatively, all patients demonstrated immediate alleviation of subjective nasal obstruction and improvement in size of ENV aperture, nostril symmetry, and overall cosmesis. Four patients showed lasting postoperative results. One patient experienced restenosis by 4 months and required revision. Our inferiorly based alar groove flap provides a reproducible solution for repositioning a medially displaced alar base. This technique reliably corrects ENV stenosis, relieves airway obstruction, and improves nasal symmetry and cosmesis.