Internal Nasal Valve Area Research Articles

Objective Parameters for Evaluating Internal Nasal Valve Compromise: Beyond the Angle Perspective.

Nasal valve surgery for internal nasal valve (INV) compromise has become increasingly popular. However, this rise in popularity has sparked debates regarding its indications and disputes over insurance coverage, primarily due to the lack of a gold-standard evaluation method. Therefore, we aimed to identify objective parameters for the INV compromise. We analyzed 186 INVs in 93 patients who underwent nasal valve surgery. The data comprised facial computed tomography (CT) images, acoustic rhinometry, the modified Cottle test, and symptom scores. Patients were categorized based on their symptoms and the. of the modified Cottle test. We measured the INV angle, area, volume, lateral wall thickness, septal angle, and nasal bone area using CT. The compromised INV group, characterized by nasal obstruction with a positive modified Cottle test, exhibited smaller INV areas in both coronal and axial views, reduced INV volume in the axial view, and a thinner lateral wall in the coronal view (all P<0.05). Acoustic rhinometry indicated a smaller minimal cross-sectional area and volume in the compromised INV group (both P<0.001). Regression analysis demonstrated significant associations between a compromised INV and reduced INV area on the axial view, as well as the minimal cross-sectional area measured by acoustic rhinometry. Relying solely on the INV angle in CT scans has limitations in assessing compromised INV. Alternatively, the INV area on axial CT scans and the minimal cross-sectional area measured by acoustic rhinometry may serve as objective parameters for evaluating INV compromise.

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 .

Correlation of Upper Lateral Cartilage Collapse and Nasal Septal Deviation

Background and Objectives: This study aimed to elucidate the relationship between nasal septal deviation (NSD) and upper lateral cartilage (ULC) collapse.Methods: We conducted a retrospective review of 142 paranasal sinus computed tomography scans from patients who had undergone septoplasty due to confirmed NSD. The ULC angle was measured on both the narrow and wide sides of the nasal cavities, and these measurements were compared to evaluate the extent of ULC collapse in relation to the degree of NSD and patient age. The correlation between the degree of NSD and the degree of ULC collapse was also analyzed.Results: The mean ULC angle was found to be 13.4°±2.7° on the narrow side and 14.3°±2.7° on the wide side, with a statistically significant difference between the two (p&lt;0.001). When comparing caudal and non-caudal NSD patients, there was no significant difference in the degree of ULC on either side (p=0.166). When comparing the ULC angle between two age groups (≥50 vs. &lt;50 years), the difference in ULC angles was significantly greater in the group of patients aged under 50 years (0.3°±3.8° vs. 1.1°±2.2°, p=0.014). There was a significant positive correlation between the degree of ULC collapse and the degree of septal deviation (r=0.214, p=0.01).Conclusion: NSD was associated with ULC collapse on the narrow side and a narrow internal nasal valve area. This result indicates that clinicians should check for concomitant ULC collapse in patients with NSD.

Three-Dimensional Computed Tomography Reconstruction and Measurement of Nasal End Deformity in Complete Unilateral Cleft Lip and Palate.

The repair of nasal deformities secondary to cleft lip and palate is complex and requires reliable preoperative nasal 3-dimensional assessment. This study explored nasal end (defined as the lower third of the external nasal and vestibular parts of the nasal cavity) deformities secondary to unilateral complete cleft lip and palate. Three-dimensional nasal end morphometric measurements were obtained from 48 patients who had undergone Millard cleft lip repair and reached skeletal maturity (cleft group) and from 36 age- and ethnicity-matched normal subjects (control group). For the cleft group, paired t tests and 1-way analysis of covariance were used to evaluate the internal and external morphological characteristics of the cleft and noncleft sides of the nasal end, and correlation analysis was done to evaluate the relationship between cleft-side measurements. In the cleft group, the cleft side showed significantly smaller nasal vestibular volume and skin area, nostril area, nasal column length, and nostril height and greater nostril base length and nasal alar length than the noncleft side (all P < 0.05). Controlling for sex, there were significant differences in the nasal vestibular volume and skin area, internal nasal valve area, long nostril diameter, nostril base length, columella length, nostril height, and nasal alar length between the cleft and control groups (all P < 0.05). On the cleft side, the area of the skin lining of the nasal vestibule positively correlated with the alar length (r = 0.67, P < 0.05). Three-dimensional nasal end reconstruction provides a more detailed preoperative nasal end morphological evaluation than previously available techniques. Level III, case-control study.

True and Average Internal Nasal Valve Area in Septorhinoplasty: Radiological and Clinical Outcomes.

The internal nasal valve provides most of the upper airway resistance; therefore, many surgical techniques have been developed to reconstruct and widen this sensitive area of the nasal airway. Twenty patients participated in this study to compare the effects of 2 techniques (spreader grafts and modified spreader flap) on the true valve area and the average valve area after rhinoplasty according to standard axial computed tomography on admission and 6 months following the surgery. The mean follow-up time was 10.2 months. After rhinoplasty, the average valve area increased in all patients who underwent the spreader graft or modified spreader flap techniques. The preoperative average valve areas for patients undergoing the spreader graft and spreader flap techniques were (37.10 ± 16.45 mm) and (36.86 ± 10.56 mm), respectively, whereas the postoperative results were (48.58 ± 12.85 mm) for those who underwent the spreader graft technique and (56.22 ± 19.06 mm) for those who underwent the modified spreader flap technique. Both techniques resulted in significant radiological and clinical improvement with a good correlation between the subjective and objective tests. LEVEL OF EVIDENCE: IV.

Computed tomography evaluation of internal nasal valve angle and area and its correlation with NOSE scale for symptomatic improvement in rhinoplasty

IntroductionNasal obstruction is one of the most frequent otolaryngologic complaints; and the collapse of the internal nasal valve is one the main causes of the nasal air flow obstruction. ObjectiveWe aimed to evaluate internal nasal valve by using reformatted CT-scans pre- and post- rhinoplasty at 3 months and to assess its correlation to symptomatic improvement of nasal obstruction using the NOSE scale. MethodsA prospective observational study was conducted between March 2017–May 2018 in a tertiary care otorhinolaryngology center. We included patients suffering from nasal obstruction secondary to internal nasal angle collapse and nasal deformity. Patients with sinusitis, nasal polyposis, and nasal masses were excluded. ResultsTwenty consecutive patients underwent rhinoplasty, with a mean age (22.2 ± 2.8), with majority of males (n = 14; 70%). There was no significant correlation between pre- and post- CT-scans of the internal nasal valve angle/area and NOSE scores. A high significant difference was detected between mean pre- and post- NOSE scores (p < 0.0001), which was absent in CT-scan results. ConclusionReformatted CT-scans measurements of internal nasal valve area and angle were not of value. NOSE scores pre- and post- rhinoplasty had a significant value to determine degree of obstructive symptom improvement.

In vivo imaging of the internal nasal valve during different conditions using optical coherence tomography.

Previously, we proposed long-range optical coherence tomography (LR-OCT) to be an effective method for the quantitative evaluation of the nasal valve geometry. Here, the objective was to quantify the reduction in the internal nasal valve angle and cross-sectional area that results in subjective nasal airway obstruction and to evaluate the dynamic behavior of the valve during respiration using LR-OCT. For 16 healthy individuals, LR-OCT was performed in each naris during: 1) normal respiration, 2) peak forced inspiration, 3) lateral nasal wall depression (to the onset of obstructive symptoms), and 4) after application of a topical decongestant. The angle and the cross-sectional area of the valve were measured. A reduction of the valve angle from 18.3° to 14.1° (11° in Caucasians and 17° in Asians) and a decrease of the cross-sectional area from 0.65 cm2 to 0.55 cm2 led to subjective nasal obstruction. Forceful breathing did not significantly change the internal nasal valve area in healthy individuals. Application of nasal decongestant resulted in increased values. LR-OCT proved to be a fast and readily performed method for the evaluation of the dynamic behavior of the nasal valve. The values of the angle and the cross-sectional area of the valve were reproducible, and changes in size could be accurately delineated. 2b. Laryngoscope, 128:E105-E110, 2018.

The Effect of External Approach Septoplasty on Olfactory Function.

Septal deviation-induced nasal obstruction is frequently accompanied by hyposmia. The aim of this study was to evaluate the effect of external approach septoplasty on olfactory function. Thirty patients (23 males, 7 females) who had external approach septoplasty were included in the study. The age interval was 18 to 60 years (mean 33±12 years). All subjects had olfactory function and acoustic rhinometry tests in both the pre- and postoperative periods (mean interval 6 weeks ± 3 weeks). Olfactory function was determined by the "Sniffin Sticks" test. The minimum cross-sectional area from the nostril to 2.20 cm backward was referred to as MCA1, and the minimum cross-sectional area from 2.20 to 5.40 cm was referred to as MCA2, determined by acoustic rhinometry. Olfactory threshold, discrimination, and identification function improved significantly after external approach septoplasty. A statistically significant difference was also detected between pre- and postoperative left MCA1 and left MCA2 of the nasal cavities. Postoperative hyposmic and anosmic patient improvement was statistically significant. External approach septoplasty has a beneficial effect on olfaction and this effect may be partly due to interactions between the increased perception of nasal air flow, as well as surgery-associated improvement in the internal nasal valve area.

Effect of Spreader Graft on Nasal Functions in Septorhinoplasty Surgery.

The authors aimed to investigate the effect of spreader grafts on nasal function in septorhinoplasty (SRP). A prospective randomized double-blind study was conducted. Thirty patients who underwent SRP operation between October 2011 and January 2013 were divided into 2 equal groups randomly. Fifteen patients underwent SRP surgery without spreader graft technique (Group I) and 15 patients underwent SRP surgery with spreader grafts (Group II). Preoperative and postoperative evaluation included visual analog score (VAS) and acoustic rhinometry test. Visual analog scores and acoustic rhinometry measurements of Group I and Group II patients were compared. Statistically significant difference was found for VAS scores of both the sides of the nasal cavity (both before and after topical decongestion) (P < 0.05), except for the VAS on the right side of the nasal cavity before decongestion (P > 0.05). On acoustic rhinometry test the difference was statistically significant for minimal cross-sectional area (MCA) and volumetric values (VOL)-MCA1, MCA2, VOL1, VOL2 values on the left side of the nasal cavity (both before and after topical decongestion) (P < 0.05) but not on the right side of the nasal cavity (P > 0.05). Performing spreader graft technique in SRP surgery can prevent the narrowing of the internal nasal valve area after surgery and maintain adequate airway for respiration.

Nasal Valve Stabilization in Extracorporeal Septoplasty

Background: Among the different operations for septoplasty, the extracorporeal septoplasty technique basically consists in the removal of all the nasal septum, the correction of bone and cartilage deformities, and their replacement with a particular suture technique to correct the markedly deviated nasal septum especially in the internal nasal valve area. The drawbacks of this surgery technique are as follows: swelling of the mucosa in the valve area and restenosis, the development of saddle nose and septal hematoma. The aim of this study is to describe our results with a modified suture technique of the extracorporeal septoplasty (ECS), taking into account the operative time and functional results.

Intraoperative Endoscopic Suction-Assisted Evaluation of the Nasal Valve.

The study sought to identify a new method for measuring internal nasal valve patency. To determine whether intraoperative endoscopic suction-assisted evaluation of the internal nasal valve is a useful technique to assess internal nasal valve area and function. A study of 20 patients undergoing cosmetic and functional septorhinoplasty from May 1 through October 31, 2012, at a private surgical practice was performed. A follow-up study was performed 3 years postoperatively on 7 patients. A photograph of the internal nasal valve was taken endoscopically with and without suction preoperatively, postoperatively, and at 3-year follow-up. Measurement of the internal nasal valve surface areas was then performed by an evaluator masked to patient groupings. Outcome measures were surface area of the internal nasal valve as measured by standardized, endoscopic photography preoperatively, postoperatively, and at 3 years with and without suction and Nasal Obstruction Symptom Evaluation (NOSE) scale scores at 3 years comparing preoperative and postoperative symptoms. Among the 20 patients studied, 13 were female and the mean age was 26 years. No difference was found in the observed static surface area of the internal nasal valve comparing preoperative and postoperative values (72 418 vs 76 973 square pixels, P = .58). No difference was found in the observed static surface area of the internal nasal valve comparing preoperative (56 426 square pixels) and postoperative (60 011 square pixels) values (P = .58). No difference was found in the observed surface area of the internal nasal valve under negative pressure comparing preoperative (54 194 square pixels) and immediate postoperative (58 325 square pixels) values (P = .97). At 3 years, the resting surface area of the internal nasal valve was not increased with an internal nasal valve surface area mean of 56 426 square pixels preoperatively and 84 352 postoperatively (P = .09). The surface area of the internal nasal valve was increased when exposed to negative sniff pressures in the 3-year follow-up by 45% (P = .03). The surface area measured a mean of 47 683 square pixels preoperatively and 85 612 square pixels at the 3-year mark under negative pressure. The study outlines a novel technique for measuring internal nasal valve surface area and compliance preoperatively and postoperatively. Surgery on the internal nasal valve has a greater effect on the dynamic function of the internal nasal valve (ie, stiffness that can be accounted for by a mere increase in nasal valve size when measured endoscopically). The study lays the groundwork for future studies using this technique. 4.

Objective Assessment of Postoperative Outcomes in Endonasal Spreader Grafts

Objectives: Use acoustic rhinometry to objectively measure the functional outcomes of endonasal spreader grafts in patients undergoing surgical correction of internal nasal valve collapse. Methods: Eighteen adult patients undergoing open septoplasty with unilateral or bilateral endonasal spreader graft placement were recruited. Patients were asked to undergo preoperative and postoperative acoustic rhinometry to measure changes in cross-sectional area of the internal nasal valve. Postoperative subjective nasal symptoms as measured by SNOT-22 and NOSE scores were also compared to preoperative values. Results: Patients undergoing septoplasty with endonasal spreader graft placement had a statistically significant increase in the cross-sectional area of the internal nasal valve ( P &lt; .05). This was concomitant with mild improvement in SNOT-22 and NOSE scores postoperatively ( P &lt; .05). Conclusions: This study provides objective evidence of an increase in internal nasal valve area after placement of endonasal cartilage spreader grafts in combination with septoplasty.

Nasal bone length in Saudi rhinoplasty: a clinical-radiological study

BACKGROUND AND OBJECTIVESHump reduction in the presence of short nasal bones can result in significant esthetic and/or functional problems in patients seeking rhinoplasty in the Middle East. The aims of this study were to determine the mean length of nasal bones, amount of nasal dorsum it forms in relation to the whole nose, and incidence of short nasal bones in the Middle Eastern population.DESIGN AND SETTINGSA prospective study that has been carried out in a tertiary care hospital.PATIENTS AND METHODSA total of 154 patients (80 females and 74 males) who were scheduled for computed tomography scan for the paranasal sinuses were included in the study. The inclusion criteria were adults with no history of facial/nasal trauma, sinus space occupying lesions, or surgery.RESULTSIn males, the mean clinical nasal bone length was 19.59 mm and the mean radiological nasal bone length was 24.96 mm. In females, the mean clinical nasal bone length was 18.17 mm and the mean radiological bone length was 22.82 mm.CONCLUSIONThe bony vault represents 44.2% of the female nose and 44.3% of the male nose. In the present study, no patients displayed a short nasal bone that was less than one-third of the whole nasal length.

The Use of Short Spreader Grafts in Rhinoplasty for Patients with Thick Nasal Skin

Thick nasal skin presents a challenge in rhinoplasty. Conventional spreader grafts in patients with thick nasal skin may result in an undesirable widening of the lower half of the nose where the nasal skin is thick. The use of short spreader grafts was evaluated in patients with thick nasal skin. For this study, 32 patients underwent closed rhinoplasty in which short spreader grafts were used. The spreader graft was 1 to 2 cm long and extended only to the transition of thin and thick nasal skin. The patients were followed for more than 1 year postoperatively. Aesthetic improvement was observed in all the patients. Nasal airway patency was improved or maintained in 94 % of the patients. Short spreader grafts effectively restore or maintain the internal nasal valve area after dorsal hump reduction while allowing for more aggressive narrowing of the lower part of the nose where nasal skin is thick. 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 .

Spreader graft in septo-rhinoplasty

The aim of study was to evaluate the effects of spreader graft in septorhinoplasty. The study group comprised of 33 patients of various nasal deformities who underwent consecutive septorhinoplasty at Asan Medical Center, University of Ulsan, College of Medicine, Republic of Korea (South Korea). All the patients had undergone open rhinoplasty procedure. The submucous resection of septum was done, leaving 1 to 1.5 cm. of septal cartilage for dorsal and caudal support. The spreader graft was harvested from septal cartilage in 31 cases and costal cartilage in 2 cases. All the patients had undergone endonasal high to low to high osteotomy, paramedian osteotomy and percutaneous transverse osteotomy.The periosteum was not elevated in any case. The spreader graft was placed and secured with septal cartilage and upper lateral cartilage with suture material. Crushed small pieces of septal cartilage were used for dorsal augmentation. The tutuplast fascia lata was used to camouflage the dorsal irregularity. All the cases had good aesthetically dorsal line, opening of internal nasal valve area and good septal support, which was weakened by the removal of deviated septum.

The Effect of Rhytidectomy on the Nasal Valve

To determine the effect of deep-plane rhytidectomy on the cross-sectional area of the nasal cavity in the vicinity of the nasal valves and to compare this quantitative measure with patients' subjective assessment of their postoperative nasal airway. An inception cohort of 17 patients undergoing rhytidectomy (either cheek-lift or face-lift) for facial rejuvenation was evaluated with acoustic rhinometry. Initial measurements were taken approximately 1 week prior to surgery, followed by postoperative measurements at 1 week and again at 1 month (a total of 18 measurements per patient). Patients undergoing simultaneous nasal procedures were excluded. Control subjects consisted of patients undergoing facial plastic procedures other than rhytidectomy or septorhinoplasty (n = 3). The main outcome measure was cross-sectional area of both the internal and external valve regions as determined by acoustic rhinometry. The setting was an ambulatory surgery center at a large academic institution. Seventy percent of patients (12 of 17) reported subjective improvement of their nasal airway patency following rhytidectomy, whereas no control subjects (0%) reported any such change. Eighty-eight percent of patients (15 of 17) had a substantial increase in the dimension of their internal nasal valve area as measured with acoustic rhinometry at 1 week, with 70% of patients demonstrating increase at 1 month. Fifty-three percent of patients (9 of 17) demonstrated an increase in their external valve area at 1 week, and 59% had a persistent increase as measured at 1 month. No control subjects demonstrated any significant nasal valve area increases at either time. There was no correlation between age or body mass index and the measurement outcomes among participants. While there is a statistically significant increase in both the internal and external nasal valve cross-sectional areas at 1 month after rhytidectomy, the permanency of this effect is unknown. In support of these findings, a sizable proportion of patients undergoing rhytidectomy subjectively report an increase in their ability to breathe through their noses, lending credence to a postrhytidectomy melonasal effect.