Nasal Valve Collapse Research Articles

A functional tool to differentiate nasal valve collapse from other causes of nasal obstruction: the FRIED test.

Nasal valve collapse is a dynamic abnormality that is currently diagnosed purely on the basis of clinical features and thus subject to certain interpretation. The aim of this study was to develop a new and reliable functional test to objectively characterize nasal valve collapse. This was an observational prospective study including consecutive patients referred to our center for exploration of chronic nasal congestion. The patients were classified into two groups according to their symptoms and clinical abnormalities: the nasal valve collapse (NV+) group when nasal valve collapse was clinically detected during moderate forced inspiration and/or when the feeling of nasal congestion improved during passive nasal lateral cartilage abduction (n = 32); and the no-nasal valve collapse (NV-) group for the others (n = 23). All patients underwent nasal functional tests (posterior rhinomanometry and acoustic rhinometry) before and after topical nasal decongestion. We compared the difference between the pressure flow of the inspiratory and expiratory phases during posterior rhinomanometry [flow rate inspiratory-expiratory difference (FRIED) test] between the two groups. The difference between the absolute value of inspiratory and expiratory flow was significantly higher in the NV+ group than in the NV- group both before and after topical decongestion. The cutoff value for the FRIED test was -0.008 l/s with a good sensitivity (82%) and a specificity of 59%. We suggest that the FRIED test constitutes an objective and easy-to-apply technique to diagnose nasal valve collapse in daily practice.

A systematic review of the surgical techniques for the treatment of internal nasal valve collapse: where do we stand?

A myriad of interventions have been described to address the restoration or preservation of the internal nasal valve, the narrowest portion of nasal airway. To review systematically available knowledge and evidence about management options of the collapse of the internal nasal valve area. Systematic review. A MEDLINE, EMBASE, Cochrane Library and CENTRAL database search, followed by extensive hand searching for the identification of relevant studies. Review of all English-language studies addressing the treatment of the internal nasal valve collapse. Fifty-three studies were eventually identified and systematically reviewed. The majority (50 of 53) of the included articles are graded as level IV evidence and only one randomised trial was identified. The included randomised study reported no significant difference in improvement between the intervention group (autospreader flap) and placebo arms. The majority of the included studies presented in this systematic review provide level IV evidence concerning the optimal approach for cases of nasal valve collapse. Current research is driven more by reports of techniques than patient outcomes. Proper evaluation and identification of the cause of the internal nasal valve collapse is paramount prior to selection of the preferred surgical solution. The three-dimensional construction of the nasal valve implies that many pathologies cannot be restored by a single solution. Treatment approaches should be directed at specific involved sites. Present systematic review of the literature revealed that the available evidence is based on low-level studies and focuses more on the description of various surgical techniques rather than on patient-reported outcome measures. Future studies are needed, including homogenous patient groups, comparing different surgical techniques and incorporating patient-reported outcome measures.

Spreader Grafts in Functional Rhinoplasty.

Management of the middle vault is paramount to achieving optimal aesthetic and functional outcomes in rhinoplasty. The ideal treatment for middle vault complications, such as internal nasal valve collapse, inverted-V deformity, and middle vault dorsal asymmetry, is prevention. Risk factors for middle vault problems in rhinoplasty that may be identified in preoperative consultation include short nasal bones, long and weak upper lateral cartilages, thin skin, previous trauma or surgery, preoperative positive Cottle maneuver, tension nose deformity, and anteriorly positioned inferior turbinates. When any of these risk factors are identified, preventive measures should be pursued. These include preservation of middle vault support structures, judicious resection in dorsal hump reduction, use of conservative osteotomies, and reconstruction of the cartilaginous middle vault with structural grafting. Spreader grafts have become the workhorse in middle vault reconstruction. They are invaluable in restoring nasal dorsal aesthetic lines, repairing or maintaining the internal nasal valve, and buttressing a corrected crooked nose. Functional and aesthetic problems related to the middle nasal vault are among the most common reasons for patients seeking revision rhinoplasty. Although complications in rhinoplasty are inevitable, underlying their etiology and instituting prophylactic treatment can significantly help reduce their occurrence.

The Conchal Cartilage Butterfly Graft.

Nasal obstruction due to weakening of the nasal sidewall is a very common patient complaint. The conchal cartilage butterfly graft is a proven technique for the correction of nasal valve collapse. It allows for excellent functional results, and with experience and attention to technical detail, it may also provide excellent cosmetic results. While this procedure is most useful for restoring form and function in cases of secondary rhinoplasty following the reduction of nasal support structures, we have found it to be a very powerful and satisfying technique in primary rhinoplasty as well. This article aims to describe the butterfly graft, discuss its history, and detail the technical considerations which we have found useful.

Innovations in nasal valve surgery.

This article reviews current practices in nasal valve repair and highlights recent innovations in the medical literature. A surgeon's choice regarding a proper nasal valve repair technique depends heavily on the patient's site of obstruction. While classical maneuvers to improve the internal and external nasal valves have been employed for several decades, increasing understanding of lateral wall insufficiency and its role in nasal valve compromise has led to improvement of proposed methods for correcting the nasal valve. Radiofrequency-induced thermotherapy, the upper lateral strut graft, stairstep graft, and nasal valve lift techniques are described in detail. These four techniques offer innovative means of dealing with the challenge of nasal valve collapse resulting in nasal obstruction. This review article provides an overview of the current practice in the field of nasal valve repair and summarizes recent technical advances in the field.

Acoustic rhinometry and video endoscopic scoring to evaluate postoperative outcomes in endonasal spreader graft surgery with septoplasty and turbinoplasty for nasal valve collapse.

BackgroundNasal obstruction is a common complaint seen by otolaryngologists. The internal nasal valve (INV) is typically the narrowest portion of the nasal cavity, and if this area collapses on inspiration the patient experiences significant symptoms of nasal obstruction. The nasal obstruction is further compounded if the INV is narrower than normal. Previous studies have evaluated the effectiveness of techniques to alleviate structural nasal obstruction, but none have looked specifically at spreader grafts measured by acoustic rhinometry or validated grading assessment of dynamic INV collapse. Our objective was to evaluate the application of acoustic rhinometry coupled with visual endoscopic grading of the INV, and validated subjective measurements, in patients undergoing endonasal spreader graft surgery with septoplasty and turbinoplasty.MethodsThis is a prospective clinical study conducted within a tertiary care rhinoplasty practice. Patients undergoing septoplasty and bilateral inferior turbinoplasty with bilateral endonasal spreader graft placement for observed internal nasal valve collapse were recruited. Baseline, early and intermediate postoperative measures were obtained. The primary outcome was grading of the INV collapse on video endoscopy. Secondary outcomes included cross-sectional area at the INV measured by acoustic rhinometry, subjective Nasal Obstruction Symptom Evaluation (NOSE) and Sino-Nasal Outcome Tool (SNOT-22) scores.ResultsA total of 17 patients, average age of 34.5 ± 12.2 years, undergoing septoplasty, bilateral endonasal spreader grafts, and bilateral turbinoplasty were included in the study. Postoperative measurements were performed at an average of 8.1 ± 1.6 weeks and 17.7 ± 4.2 weeks. Patients had significant improvement for INV collapse grading, cross-sectional area, NOSE and SNOT-22 scores in both the early and intermediate follow up. Endoscopic grading had moderate inter-rater agreement (κ = 0.579) and average intra-rater agreement (κ = 0.545).ConclusionsThis study is the first to demonstrate a statistically significant improvement of objective measurement of internal nasal valve function, both static and dynamic, and subjective improvements. This supports endonasal cartilagenous spreader grafts with septoplasty and inferior turbinoplasty for patients with nasal obstruction with internal nasal valve collapse.

Diagnosis and Treatment of Dynamic External Nasal Valve Collapse: Application of Alar Batten Graft and Alar Flaring Suture

Diagnosis and Treatment of Dynamic External Nasal Valve Collapse: Application of Alar Batten Graft and Alar Flaring Suture

Evaluation of Improvement in Nasal Obstruction Following Nasal Valve Correction in Patients With a History of Failed Septoplasty.

Patients with a septal deviation and concerns about nasal obstruction often undergo septoplasty to improve nasal airflow. Following primary septoplasty, however, some patients have persistent symptoms due to nasal valve dysfunction and may require nasal valve surgery. To evaluate the change in disease-specific quality of life for patients who undergo nasal valve correction after failed septoplasty using the Nasal Obstruction Symptom Evaluation (NOSE) survey and to determine whether identifiable anatomical risk factors are more common in patients with a history of failed septoplasty. Prospective observational outcomes study conducted at a tertiary care medical center. Forty patients who underwent nasal valve correction through an open approach from January 1, 2012, through December 31, 2014, with a history of septoplasty for nasal obstruction were included. Data analysis was conducted from January 1, 2013, through May 1, 2015. [corrected]. Demographic information, a standardized nasal examination, and preoperative and postoperative NOSE scores were collected and reviewed. Comparison between preoperative and postoperative NOSE scores at 2, 4, and more than 6 months after surgery. Forty patients were included in the study; 23 (57%) were male and 17 (43%) were female. The mean age was 39.3 years. Findings from preoperative nasal examination demonstrated moderate or severe internal nasal valve narrowing in 38 (95%) patients, internal nasal valve collapse in 19 (48%), external nasal valve narrowing in 18 (45%), or external nasal valve collapse in 16 (40%). The most common anatomical cause of obstruction was internal nasal valve narrowing in 38 (95%) patients, dorsal septum deflection in 26 (65%), and narrowed middle vault in 16 (40%). The mean (SD) preoperative NOSE score was 75.7 (20.1). Mean (SD) postoperative NOSE scores at 2, 4, and greater than 6 months were 31.4 (27.2), 34.0 (19.8), and 22.1 (18.8), respectively, with significantly improved NOSE scores at each time point compared with before surgery (P < .001). Nasal valve dysfunction remains an underdiagnosed entity and should be considered in all patients with septal deviation before septoplasty, especially in patients with a severe dorsal deflection and a narrow middle vault. In this study, surgical nasal valve correction demonstrated a significant reduction in nasal obstruction, as measured by a validated outcome measure, in patients for whom a previous septoplasty had failed. 4.

Update on the evidence for functional rhinoplasty techniques.

Functional rhinoplasty is a term that is commonly used to describe any technique used to address nasal obstruction in the nasal valve region. The cause of nasal valve collapse differs based on the site. Internal valve collapse may be idiopathic or associated with previous rhinoplasty, trauma, or weakened cartilage in older patients. External valve collapse is usually idiopathic and less likely to be associated with previous surgery. Various techniques have been developed over time, and the data in support of functional rhinoplasty continue to increase. This article discusses popular techniques currently in use, as well as newer techniques that have been described over the past several years. In addition, there is a trend toward utilizing objective testing and validated assessment scales to assess postoperative changes. Functional rhinoplasty utilizes a multitude of techniques to address nasal valve collapse. Although high-level data are lacking, the current literature is in support of nasal valve correction to improve nasal breathing. Most importantly, the technique employed is unique for each patient.

Titanium mesh in reconstructive surgery of the nasal pyramid. Follow-up of our 11 initial cases.

Titanium mesh has been employed in neurosurgery, plastic surgery, and maxillofacial surgery as a bone replacement in diverse conditions. We first reported on its use as a substitute for osteocartilaginous nasal structure with satisfactory functional and aesthetic results in 2009. To assess the utility and tolerance of titanium mesh as a substitute of the osteocartilaginous portion of the nose. Eleven patients were identified who had a nasal reconstruction with titanium mesh. We retrospectively searched for infection, extrusion, nasal valve collapse, second surgery, and patient satisfaction in the patients' records. All patients presented with various types of non-melanoma skin cancer in the nasal pyramid. In the reconstruction of full-thickness nasal defects, local flaps were used, employing titanium mesh as a support structure. No mesh extrusions, infections, or collapse of the nasal valve were noted in patients with a mean follow-up of fiveyears. Only one patient needed a second surgery to debulk the flap. Patient satisfaction achieved a mean score of 7.5 out of 9 in 10 patients. As cartilage grafts need a second surgical site, with consequent morbidity, the use of titanium mesh proves useful and safe in the reconstruction of nasal full-thickness defects. The results of our series of patients demonstrate the suitability of this material in the repair of nasal osteochondral defects, as well as its low rate of complications.

Alar Suspension Sutures in the Management of Nasal Valve Collapse.

This study assesses the efficacy of alar suspension sutures in the management of nasal valve collapse causing nasal obstruction. These sutures are inserted between the vestibular skin and lateral crura and hitched to the periosteum of the medial inferior orbital margin; this is a variation of the alar (change everywhere) suspension suture technique. A retrospective review of patients who underwent alar suspension suture insertion between January 2009 and December 2010 in the management of nasal obstruction was undertaken. Symptoms of nasal obstruction were assessed using the Visual Analogue Scale (VAS) and peak inspiratory flow rate (PIFR). This was measured preprocedure and repeated at 3, 6, and 12 months postoperatively. A total of 35 patients were identified, and 26 were included in the study; 90% of patients were satisfied with the outcome of surgery, supported by improvement in the VAS and PIFR scores. The mean difference in VAS preprocedure and postprocedure was 4.97 (P value = 0.00), and the average improvement in PIFR was 25.5 L/min (P value = 0.00). Our study shows a significant improvement in patient's symptoms following insertion of alar suspension sutures. It is, therefore, a reliable, safe, and effective technique in treating nasal obstruction secondary to nasal valve collapse.

Prospective evaluation of quality-of-life improvement after correction of the alar base in the flaccidly paralyzed face.

Nasal valve collapse caused by facial palsy is an often overlooked but disturbing sequela of flaccid facial paralysis. To prospectively study the effect of fascia lata sling placement for correction of external nasal valve compromise in patients with flaccid facial paralysis, using a validated disease-specific quality-of-life outcome survey. This was a prospective study of 68 patients from March 2009 to December 2013 who underwent fascia lata sling placement for correction of external nasal valve compromise. Fascia lata sling placement for the correction of external nasal valve compromise . Nasal Obstruction Symptom Evaluation (NOSE) scale. Sixty-eight disease-specific quality-of-life determinations were performed using the NOSE scale. Ratings were ascertained preoperatively and postoperatively. Sixty patients completed a NOSE scale prior to surgical intervention, and 40 completed the survey after intervention. There was a statistically significant difference in NOSE scores after fascia lata sling placement The mean preoperative NOSE score was 37.6 (27.1), and the mean postoperative score was 16.6 (17.37) (Wilcoxon signed-rank test; P < .001). All patients had improvement in their nasal obstruction, which persisted uniformly in follow-up. The nasal valve is a zone that has historically been neglected, despite the fact that a highly effective surgical solution has existed for decades. We highlight the significance of nasal valve dysfunction in patients with flaccid facial paralysis, demonstrate a quantitative benefit in disease-specific quality of life after fascia late sling placement for external nasal valve compromise, and suggest an updated treatment algorithm. This method offers a predictably successful, straightforward surgical solution to an overlooked functional problem in the patient with flaccid facial paralysis. 4.

Computerized analysis of acoustic characteristics of patients with internal nasal valve collapse before and after functional rhinoplasty

Acoustic analysis of sounds produced during speech provides significant information about the physiology of larynx and vocal tract. The analysis of voice power spectrum is a fundamental sensitive method of acoustic assessment that provides valuable information about the voice source and characteristics of vocal tract resonance cavities. The changes in long-term average spectrum (LTAS) spectral tilt and harmony to noise ratio (HNR) were analyzed to assess the voice quality before and after functional rhinoplasty in patients with internal nasal valve collapse. Before and 3 months after functional rhinoplasty, 12 participants were evaluated and HNR and LTAS spectral tilt in /a/ and /i/ vowels were estimated. It was seen that an increase in HNR and a decrease in LTAS spectral tilt existed after surgery. Mean LTAS spectral tilt in vowel /a/ decreased from 2.37 ± 1.04 to 2.28 ± 1.17 (P = 0.388), and it was decreased from 4.16 ± 1.65 to 2.73 ± 0.69 in vowel /i/ (P = 0.008). Mean HNR in the vowel /a/ increased from 20.71 ± 3.93 to 25.06 ± 2.67 (P = 0.002), and it was increased from 21.28 ± 4.11 to 25.26 ± 3.94 in vowel /i/ (P = 0.002). Modification of the vocal tract caused the vocal cords to close sufficiently, and this showed that although rhinoplasty did not affect the larynx directly, it changes the structure of the vocal tract and consequently the resonance of voice production. The aim of this study was to investigate the changes in voice parameters after functional rhinoplasty in patients with internal nasal valve collapse by computerized analysis of acoustic characteristics.

The pull-up spreader high (PUSH) technique for nasal tip support.

Nasal tip depression is associated with nasal valve collapse. The pull-up spreader high (PUSH) technique was developed to enlarge the nasal dorsum and upwardly rotate and define the nasal tip by lifting the domes. The authors reviewed a case series to assess the long-term effectiveness of the PUSH technique in improving nasal airflow and aesthetic outcomes. This retrospective study included 50 consecutive cases of PUSH rhinoplasty. Objective (acoustic rhinomanometry) and subjective (patient questionnaire) evaluations of the stability of the aesthetic result and improvement of airflow were conducted before and 3 years after PUSH rhinoplasty. PUSH rhinoplasty resulted in long-term stability of the aesthetic effect. All patients had pleasing aesthetic results and a general improvement in the nasal airway. When the degree of nasal obstruction was scored from 1 (greatest obstruction) to 10 (least obstruction), 22 patients rated their nasal function improved to a score of 10 and 28 patients to a score of 8. Rhinomanometry indicated that only 1 patient had worsened nasal airflow. The PUSH technique enables stable upward rotation and improved definition of the severely depressed nasal tip through an open approach. 4.

Tip extension suture: a new tool tailored for Asian rhinoplasty.

Recent changes in the release and rebuilding of the tripod structure during Asian rhinoplasty have allowed for additional lengthening and rotation of the nasal tip. To rebuild the nasal tip framework, we used the tip extension suture technique alone or in combination with other procedures. A retrospective, longitudinal study was conducted to evaluate the safety and efficacy of the tip extension suture technique for use in Asian rhinoplasty. From May of 2008 to December of 2011, 283 Asian patients underwent the tip extension suture technique and were postoperatively monitored for 6 months or longer. The tip extension suture surgical technique involves advancing the lateral crus, which is fully released from the pyriform margin-supported hinge areas, and fixing it to the caudal septum. The patients' medical charts and serial photographs were analyzed to assess outcome stability, complications (pinched deformity, skin necrosis, airway problems, or nasal valve collapse), patient satisfaction, and the need for revision surgery. This technique allowed most patients to retain an altered nasal tip shape during the follow-up period. The nasal tip was incompletely corrected in 14 patients (4.9 percent), and surgical revision owing to development of pinched deformities was required in eight patients (2.8 percent). Ultimately, 92 percent of the patients were satisfied with their outcomes. Complications, such as circulation or airway problems, did not occur. This study describes and recommends a new tip extension suture procedure for rebuilding the released nasal tip framework during Asian rhinoplasty, with fewer aesthetic and functional complications. Therapeutic, IV.

The stairstep graft: an alternative technique in nasal valve surgery.

The stairstep graft is a novel method to modify the lateral anchoring point of lateral grafts for nasal valve correction. Eight consecutive patients with a diagnosis of nasal valve collapse were included in the study. The novel method of stairstep grafts was performed to reinforce the lateral crus and to widen the nasal valve. Postoperative evaluations were performed by using questionnaires and photographs. After a minimum follow-up of 3 months, all patients reported an improvement of nasal airway postoperatively. Persistent normalization of the preoperatively narrow alar base was noted. The stairstep graft introduces a new concept in nasal valve surgery by lateralization of the lateral anchoring point for the alar strut graft (or other lateral functional grafts). The concept seems logical, enhances an existing technique, and may be performed through a minimally invasive approach, and the potential for untoward effects seems to be low.

Comprehensive Repair of the Nasal Valve in the Management of Obstructive Sleep Apnea

Objectives: To analyze whether the nasal valve cartilage repositioning procedure described here results in a significant improvement in patients with obstructive sleep apnea (OSA). Methods: This is a prospective case series conducted at a university public hospital from 2011 to 2014. Adult patients who had OSA, nasal obstruction with valve collapse, and body mass index less than 30 were included in the study. All patients had a cartilage repositioning L-strut septoplasty via full transfixion incision. Specifically, the septal dorsum is exposed, released from the upper lateral cartilages and bony septum, and repositioned in the midline and fixated to the nasal spine, thus restoring the L-strut position. In addition, the nasal sidewalls were repaired using the Alar™ endonasal stent device to reposition the upper lateral and lower lateral cartilage after release into positions of increased overlap, thus increasing the diameter of the nasal valve. Preoperative and postoperative (3 months) polysomnograms were obtained. Statistical analysis using the paired t-test was used to determine significance. Results: Fifteen patients were included in this study. Average apnea-hypopnea index (AHI) scores preoperatively were 24. Postoperative AHI scores averaged to 13, a reduction of 54% ( P = .04). Only 3 out of 15 patients showed no improvement. Conclusions: The comprehensive repair of the nasal valve including repair of the nasal sidewalls and septal L-strut can significantly improve the severity of OSA for select patients. This is a fast and minimally invasive approach to consider in patients with OSA and nasal valve collapse.

Quantitative Analysis of Functional Rhinoplasty Procedures: A Cadaveric Study to Evaluate a Novel Assessment Technique

Objectives: A wide array of surgical techniques has been developed to address internal nasal valve collapse. In particular, butterfly grafts and spreader grafts are used ubiquitously without any objective comparison being made on the efficacy of these approaches. The objective of this study was to quantitatively assess the effect that these techniques have on lateral nasal wall compliance. Methods: A total of 11 fresh nonfixed cadavers (22 valves) were utilized for this study. Baseline measurements of lateral wall compliance were performed using a tension gauge and a novel procedure (herein described), and each nasal valve was measured independently. The valves were augmented with butterfly graft, endonasal spreader graft, and open spreader graft. Lateral nasal wall compliance was measured after each technique, and statistical analysis was performed. Results: There was an increase in force required to displace the lateral nasal wall compared with baseline after butterfly and endonasal spreader techniques ( P &lt; .05). The greatest effect was after butterfly-type graft placement ( P &lt; .05). An endonasal spreader graft technique resulted in a stiffer lateral nasal wall when compared to the open technique ( P &lt; .05). Open spreader graft had no effect relative to baseline measurements. Conclusions: This cadaveric study describes the application of a novel assessment tool used to quantitatively compare different grafting techniques used in functional rhinoplasty. Butterfly grafts are the most effective in strengthening the lateral nasal wall. Endonasal spreader grafts are also effective to a lesser degree. Open spreader techniques had no effect on the compliance of the lateral nasal wall.

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.

Pediatric nasal valve surgery: Short-term outcomes and complications

ObjectivesTo examine the short-term outcomes and complications of open nasal valve surgery in children under 16 years of age. Study design: case series and chart review study setting: an urban, tertiary, pediatric otolaryngology practice. MethodsChildren under 16 years of age who had undergone nasal valve surgery with cartilage grafting for functional indications were identified. Patients with cleft-related nasal deformities were excluded. Charts were reviewed for indications and short-term outcomes (patient satisfaction and postoperative complications within the first 90 days). A literature review assessed prior outcomes in adult nasal valve patients. ResultsFifteen pediatric patients, 15 years old or younger, were identified as having undergone open nasal valve repair utilizing septal or auricular cartilage grafts. Patient age ranged from 6 to 15 years. Surgical indications were nasal obstruction with nasal valve stenosis related to either previous trauma (n=10), congenital deformity (n=3), iatrogenic injury (n=1) or hemangioma of infancy (n=1). All patients noted improvement of symptoms at the 90 day interval or later. There was one episode of self-limited epistaxis, which occurred on postoperative day 7 following splint removal. ConclusionsIn children, an obstructive nasal breathing pattern may be caused by nasal valve collapse, which can be addressed with nasal valve surgery. This small series suggests that short-term results in children may be similar to those observed in the adult population. Pediatric nasal valve surgery outcomes have not been described previously; studies focused on long-term outcomes following pediatric nasal valve surgery are needed. Level of evidence4.