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J Cosmet Med 2021; 5(2): 67-73

Published online December 31, 2021

https://doi.org/10.25056/JCM.2021.5.2.67

Surgical correction of nasal valve collapse

Joo Yeon Kim , MD, PhD, Gi Yoon Nam , MD, Jae Hwan Kwon , MD, PhD

Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Rep. of Korea

Correspondence to :
Jae Hwan Kwon
E-mail: entkwon@hanmail.net

Received: November 10, 2021; Revised: November 29, 2021; Accepted: December 9, 2021

© Korean Society of Korean Cosmetic Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Nasal obstruction due to internal and/or external nasal valve collapse can be occurred sometimes. To overcome internal nasal valve obstruction, spreader grafts, butterfly grafts, flaring sutures and suspension sutures have been described to be effective. The correction of the external valve collapse can be done by alar batten, alar rim graft, and various other methods. Objective: We report successful results for the patients with severe nasal valve collapse during respiration using appropriate surgical techniques for individual causes.
Methods: We undertook a retrospective study of 8 patients diagnosed with nasal valve collapse. Each patient underwent one or multiple procedures according to individual problems regard to their nasal obstruction. The visual analogue scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE) validated survey was used to measure a patient’s subjective postoperative change in nasal obstruction. Facial photography and video for estimating alar collapse were taken to compare the change of pre- and postoperative nasal breathing and shape.
Results: Four out of eight patients had a static collapse of the nasal valves, while the other four had a dynamic collapse. The remaining six patients had no previous nasal trauma or surgical history. Each patient underwent surgeries such as alar batten graft, alar rim graft, and debulking operation according to their respective deformities. The endonasal and open approaches were used in five and three patients, respectively. After surgery, patient satisfaction (VAS) improved from 6.6 to 2.5 points, and the NOSE scale scores improved from 15.1 to 7.1 points.
Conclusion: Nasal obstruction due to nasal valve collapse can be effectively treated with various surgical techniques. After a thorough examination and analysis, the underlying cause of the nasal obstruction should be analyzed, and one or multiple procedures should be chosen according to each individual problem to get good results.

Keywords: nasal valve collapse, nasal valve surgery, rhinoplasty

Fig. 1.(A) Change of pre- and postoperative VAS. (B) Change of pre- and post-operative NOSE scale. VAS, visual analogue scale; NOSE, nasal obstruction symptom evaluation.
  1. Jung DH, Kim YJ, Choi WS, Han CJ, Jang TY. Treatment of the nasal valve stenosis. Korean J Otorhinolaryngol-Head Neck Surg 1999;42:727-33.
  2. Fischer H, Gubisch W. Nasal valves--importance and surgical procedures. Facial Plast Surg 2006;22:266-80.
    Pubmed CrossRef
  3. Schlosser RJ, Park SS. Functional nasal surgery. Otolaryngol Clin North Am 1999;32:37-51.
    CrossRef
  4. Friedman M, Ibrahim H, Syed Z. Nasal valve suspension: an improved, simplified technique for nasal valve collapse. Laryngoscope 2003;113:381-5.
    Pubmed CrossRef
  5. Toriumi DM, Josen J, Weinberger M, Tardy ME Jr. Use of alar batten grafts for correction of nasal valve collapse. Arch Otolaryngol Head Neck Surg 1997;123:802-8.
    Pubmed CrossRef
  6. Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 1984;73:230-9.
    Pubmed CrossRef
  7. Stucker FJ, Hoasjoe DK. Nasal reconstruction with conchal cartilage. Correcting valve and lateral nasal collapse. Arch Otolaryngol Head Neck Surg 1994;120:653-8.
    Pubmed CrossRef
  8. Paniello RC. Nasal valve suspension. An effective treatment for nasal valve collapse. Arch Otolaryngol Head Neck Surg 1996;122:1342-6.
    Pubmed CrossRef
  9. Dutton JM, Neidich MJ. Intranasal Z-plasty for internal nasal valve collapse. Arch Facial Plast Surg 2008;10:164-8.
    Pubmed CrossRef
  10. Chang J. Surgery for nasal valve compromise. Korean J Otorhinolaryngol- Head Neck Surg 2014;57:214-25.
    CrossRef
  11. Jin HR, Mo JH. Surgical correction of dynamic nasal valve collapse. Korean J Otorhinolaryngol-Head Neck Surg 2009;52:175-9.
    CrossRef
  12. Choi IJ, Kim KH, Kim NY, Lee MC. Diagnosis and treatment of dynamic external nasal valve collapse: application of alar batten graft and alar flaring suture. Korean J Otorhinolaryngol- Head Neck Surg 2016;59:551-6.
    CrossRef
  13. Rohrich RJ, Raniere J Jr, Ha RY. The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg 2002;109:2495-505; discussion 2506-8.
    CrossRef
  14. Williams JD, Romo T 3rd, Sclafani AP, Cho H. Porous highdensity polyethylene implants in auricular reconstruction. Arch Otolaryngol Head Neck Surg 1997;123:578-83.
    Pubmed CrossRef
  15. Troell RJ, Powell NB, Riley RW, Li KK. Evaluation of a new procedure for nasal alar rim and valve collapse: nasal alar rim reconstruction. Otolaryngol Head Neck Surg 2000;122:204-11.
    CrossRef
  16. Park SS. The flaring suture to augment the repair of the dysfunctional nasal valve. Plast Reconstr Surg 1998;101:1120-2.
    Pubmed CrossRef
  17. Tardy ME Jr, Garner ET. Inspiratory nasal obstruction secondary to alar and nasal valve collapse: technique for repair using autogenous cartilage. Oper Tech Otolaryngol-Head Neck Surg 1990;1:215-7.
    CrossRef
  18. Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 1997;99:943-52; discussion 953-5.
    Pubmed CrossRef
  19. Toriumi DM. Surgical correction of the aging nose. Facial Plast Surg 1996;12:205-14.
    Pubmed CrossRef
  20. Toriumi DM. Management of the middle nasal vault in rhinoplasty. Oper Tech Plast Reconstr Surg 1995;2:16-30.
    CrossRef
  21. Becker DG, Becker SS. Treatment of nasal obstruction from nasal valve collapse with alar batten grafts. J Long Term Eff Med Implants 2003;13:259-69.
    Pubmed CrossRef
  22. Byrd DR, Otley CC, Nguyen TH. Alar batten cartilage grafting in nasal reconstruction: functional and cosmetic results. J Am Acad Dermatol 2000;43(5 Pt 1):833-6.
    Pubmed CrossRef

Article

Original Article

J Cosmet Med 2021; 5(2): 67-73

Published online December 31, 2021 https://doi.org/10.25056/JCM.2021.5.2.67

Copyright © Korean Society of Korean Cosmetic Surgery.

Surgical correction of nasal valve collapse

Joo Yeon Kim , MD, PhD, Gi Yoon Nam , MD, Jae Hwan Kwon , MD, PhD

Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Rep. of Korea

Correspondence to:Jae Hwan Kwon
E-mail: entkwon@hanmail.net

Received: November 10, 2021; Revised: November 29, 2021; Accepted: December 9, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Nasal obstruction due to internal and/or external nasal valve collapse can be occurred sometimes. To overcome internal nasal valve obstruction, spreader grafts, butterfly grafts, flaring sutures and suspension sutures have been described to be effective. The correction of the external valve collapse can be done by alar batten, alar rim graft, and various other methods. Objective: We report successful results for the patients with severe nasal valve collapse during respiration using appropriate surgical techniques for individual causes.
Methods: We undertook a retrospective study of 8 patients diagnosed with nasal valve collapse. Each patient underwent one or multiple procedures according to individual problems regard to their nasal obstruction. The visual analogue scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE) validated survey was used to measure a patient’s subjective postoperative change in nasal obstruction. Facial photography and video for estimating alar collapse were taken to compare the change of pre- and postoperative nasal breathing and shape.
Results: Four out of eight patients had a static collapse of the nasal valves, while the other four had a dynamic collapse. The remaining six patients had no previous nasal trauma or surgical history. Each patient underwent surgeries such as alar batten graft, alar rim graft, and debulking operation according to their respective deformities. The endonasal and open approaches were used in five and three patients, respectively. After surgery, patient satisfaction (VAS) improved from 6.6 to 2.5 points, and the NOSE scale scores improved from 15.1 to 7.1 points.
Conclusion: Nasal obstruction due to nasal valve collapse can be effectively treated with various surgical techniques. After a thorough examination and analysis, the underlying cause of the nasal obstruction should be analyzed, and one or multiple procedures should be chosen according to each individual problem to get good results.

Keywords: nasal valve collapse, nasal valve surgery, rhinoplasty

Fig 1.

Figure 1.(A) Change of pre- and postoperative VAS. (B) Change of pre- and post-operative NOSE scale. VAS, visual analogue scale; NOSE, nasal obstruction symptom evaluation.
Journal of Cosmetic Medicine 2021; 5: 67-73https://doi.org/10.25056/JCM.2021.5.2.67

References

  1. Jung DH, Kim YJ, Choi WS, Han CJ, Jang TY. Treatment of the nasal valve stenosis. Korean J Otorhinolaryngol-Head Neck Surg 1999;42:727-33.
  2. Fischer H, Gubisch W. Nasal valves--importance and surgical procedures. Facial Plast Surg 2006;22:266-80.
    Pubmed CrossRef
  3. Schlosser RJ, Park SS. Functional nasal surgery. Otolaryngol Clin North Am 1999;32:37-51.
    CrossRef
  4. Friedman M, Ibrahim H, Syed Z. Nasal valve suspension: an improved, simplified technique for nasal valve collapse. Laryngoscope 2003;113:381-5.
    Pubmed CrossRef
  5. Toriumi DM, Josen J, Weinberger M, Tardy ME Jr. Use of alar batten grafts for correction of nasal valve collapse. Arch Otolaryngol Head Neck Surg 1997;123:802-8.
    Pubmed CrossRef
  6. Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 1984;73:230-9.
    Pubmed CrossRef
  7. Stucker FJ, Hoasjoe DK. Nasal reconstruction with conchal cartilage. Correcting valve and lateral nasal collapse. Arch Otolaryngol Head Neck Surg 1994;120:653-8.
    Pubmed CrossRef
  8. Paniello RC. Nasal valve suspension. An effective treatment for nasal valve collapse. Arch Otolaryngol Head Neck Surg 1996;122:1342-6.
    Pubmed CrossRef
  9. Dutton JM, Neidich MJ. Intranasal Z-plasty for internal nasal valve collapse. Arch Facial Plast Surg 2008;10:164-8.
    Pubmed CrossRef
  10. Chang J. Surgery for nasal valve compromise. Korean J Otorhinolaryngol- Head Neck Surg 2014;57:214-25.
    CrossRef
  11. Jin HR, Mo JH. Surgical correction of dynamic nasal valve collapse. Korean J Otorhinolaryngol-Head Neck Surg 2009;52:175-9.
    CrossRef
  12. Choi IJ, Kim KH, Kim NY, Lee MC. Diagnosis and treatment of dynamic external nasal valve collapse: application of alar batten graft and alar flaring suture. Korean J Otorhinolaryngol- Head Neck Surg 2016;59:551-6.
    CrossRef
  13. Rohrich RJ, Raniere J Jr, Ha RY. The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg 2002;109:2495-505; discussion 2506-8.
    CrossRef
  14. Williams JD, Romo T 3rd, Sclafani AP, Cho H. Porous highdensity polyethylene implants in auricular reconstruction. Arch Otolaryngol Head Neck Surg 1997;123:578-83.
    Pubmed CrossRef
  15. Troell RJ, Powell NB, Riley RW, Li KK. Evaluation of a new procedure for nasal alar rim and valve collapse: nasal alar rim reconstruction. Otolaryngol Head Neck Surg 2000;122:204-11.
    CrossRef
  16. Park SS. The flaring suture to augment the repair of the dysfunctional nasal valve. Plast Reconstr Surg 1998;101:1120-2.
    Pubmed CrossRef
  17. Tardy ME Jr, Garner ET. Inspiratory nasal obstruction secondary to alar and nasal valve collapse: technique for repair using autogenous cartilage. Oper Tech Otolaryngol-Head Neck Surg 1990;1:215-7.
    CrossRef
  18. Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 1997;99:943-52; discussion 953-5.
    Pubmed CrossRef
  19. Toriumi DM. Surgical correction of the aging nose. Facial Plast Surg 1996;12:205-14.
    Pubmed CrossRef
  20. Toriumi DM. Management of the middle nasal vault in rhinoplasty. Oper Tech Plast Reconstr Surg 1995;2:16-30.
    CrossRef
  21. Becker DG, Becker SS. Treatment of nasal obstruction from nasal valve collapse with alar batten grafts. J Long Term Eff Med Implants 2003;13:259-69.
    Pubmed CrossRef
  22. Byrd DR, Otley CC, Nguyen TH. Alar batten cartilage grafting in nasal reconstruction: functional and cosmetic results. J Am Acad Dermatol 2000;43(5 Pt 1):833-6.
    Pubmed CrossRef

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