Significance of Inner Nasal Valve In Septoplasty

Background: Nasal obstruction due to deviated septum is commonly treated with conventional septoplasty. This surgery however is inadequate in cases of compromised nasal valves and leads to persistent symptoms. Hence, we stressed the evaluation of nasal valves before septal surgery & studied the outcome of the patients with valve area correction. Aim:To prove the signi?cance of inner nasal valve in nasal surgery. Objective: To analyse the outcome of Open septoplasty. Methodology:A retrospective review of our patients undergoing Open septoplasty was analyzed from April 2016 to January 2021. The preoperative and post-operative evaluations were calculated & statistically analysed. Results :A total of 400 patients underwent Open septoplasty, out of which 392(98%)showed symptomatic improvement in breathing dif?culty. Also, 220 patients out of total 400 underwent cosmetic correction along with open septoplasty & 209 (95%) out of these220 were completely happy with the asthetic improvement. Conclusion:Open septoplasty and Spreader grafts is best solution to improve Internal Nasal valve angle. Rim graft to improve external valve collapse. Spreader graft also gives asthetic along with functional improvement.

Rinoplastía y rinoseptoplastía funcional: mejorando la función nasal más allá de la cirugía del tabique y los cornetes nasales / Functional rhinoplasty and septorhinoplasty: improving nasal function beyond septal and turbinate surgery

Resumen La obstrucción nasal es una de las causas más frecuentes de consulta otorrinolaringológica general. Diversas estructuras juegan un rol en la mantención de una adecuada función respiratoria nasal, incluyendo el tabique, los cornetes, las paredes laterales y las alas nasales. La cirugía del tabique y de los cornetes inferiores son los procedimientos más comúnmente realizados y aunque son efectivos en un gran porcentaje de los casos, en ocasiones se deben intervenir otras estructuras nasales para corregir adecuadamente la obstrucción. La cirugía con fines primariamente funcionales de las válvulas nasales externa e interna, de la punta y/o de la pirámide ósea se ha denominado "rinoplastía funcional". Dada la importancia de estas estructuras para la recuperación de una adecuada permeabilidad nasal estática y dinámica, el diagnóstico y manejo quirúrgico de estas condiciones debe ser de dominio del otorrinolaringólogo.

Abstract Nasal obstruction is one of the most frequent complaints in general otorhinolaryngology practice. Different structures have a role in maintaining an adequate nasal breathing function, including the septum, turbinates, lateral sidewalls and nasal alae. Surgery of the nasal septum and inferior turbinates are the most commonly performed procedures and, although effective in most cases, occasionally other nasal structures must be intervened to correctly address the sites of obstruction. The term "functional rhinoplasty" has been coined for surgery of the external and internal nasal valves, nasal tip and/or bony pyramid, with primarily functional objectives. Given the importance of these structures for restoring an adequate static and dynamic nasal patency, diagnosis and management of these conditions must be dominion of the otorhinolaryngologist.

Manejo del colapso de válvula nasal externa: revisión de la literatura / Management of external nasal valve collapse: literature review

La rinoplastia es una de las cirugías estéticas más realizadas en el mundo y entre las complicaciones más frecuentes está el colapso valvular por la excesiva resección del cartílago alar. La parálisis facial, así como el envejecimiento pueden colapsar la pared lateral en inspiración por disfunción del músculo nasal, al provocar debilitamiento del tejido fibroalveolar de la pared lateral nasal, existiendo también causas genéticas que producen colapso valvular. Actualmente se practican diversas técnicas para mejorar el colapso valvular y ninguna es cien por ciento efectiva, la mayor parte se centran en corregir la propia válvula nasal o el cartílago triangular, lo que indica que se fijan en un solo factor y no en la etiología multifactorial que la produce. Este estudio revisa la evidencia clínica que guía a un diagnóstico correcto y al manejo efectivo de la disfunción de la válvula nasal externa, mediante el uso de diversas técnicas que se emplean actualmente para perfeccionar el colapso valvular nasal.

Rhinoplasty is one of the most frequent cosmetic surgeries in the world and among the most common complications is valve collapse due to excessive resection of the alar cartilage. Facial paralysis, as well as aging, can collapse the lateral wall in inspiration due to dysfunction of the nasal muscle, causing weakening of the fibroalveolar tissue of the nasal lateral wall, and there are also genetic causes that produce valve collapse. Currently, various techniques are practiced to improve valve collapse and none are one hundred percent effective, most of them focus on correcting the nasal valve itself or the triangular cartilage, which indicates that they are fixed on a single factor and not on multifactorial etiology that produces it. This study reviews the clinical evidence that guides a correct diagnosis and effective management of external nasal valve dysfunction, using various techniques that are currently used to improve nasal valve collapse.

Válvula nasal en rinoplastía / Nasal valve in rhinoplasty

RESUMEN La obstrucción dependiente de la vía aérea nasal representa un gran impacto en la calidad de vida de los pacientes. Las causas de ésta son múltiples, donde aquellas de tipo estructural son las que requieren frecuentemente cirugía. La obstrucción nasal debido a la disfunción de la válvula nasal puede ser olvidada como única causa de una obstrucción nasal. La decisión sobre qué técnica quirúrgica utilizar para solucionar una insuficiencia valvular es compleja y muchas veces la bibliografía utiliza conceptos anatómicos muy variados que no ayudan a seleccionar una técnica en particular. Se realizó una revisión bibliográfica del tema destacando anatomía, diagnóstico y tratamiento; las técnicas quirúrgicas más frecuentemente utilizadas son descritas.

ABSTRACT Nasal airway obstruction represents a major impact on patients' quality of life. The causes are multiple, where those of a structural type, frequently require surgery. Nasal obstruction due to nasal valve dysfunction may be overlooked as a cause of nasal obstruction. The decision about which surgical technique to use in order to solve a valvular insufficiency is complex and often the literature uses diverse anatomical concepts that do not help to select a particular technique. A literature review of the subject was carried out, highlighting anatomy, diagnosis and treatment; The most frequently used surgical techniques are described.

Investigation on the nasal airflow characteristics of anterior nasal cavity stenosis

We used a computational fluid dynamics (CFD) model to study the inspiratory airflow profiles of patients with anterior nasal cavity stenosis who underwent curative surgery, by comparing pre- and postoperative airflow characteristics. Twenty patients with severe anterior nasal cavity stenosis, including one case of bilateral stenosis, underwent computed tomography (CT) scans for CFD modelling. The pre- and postoperative airflow characteristics of the nasal cavity were simulated and analyzed. The narrowest area of the nasal cavity in all 20 patients was located within the nasal valve area, and the mean cross-sectional area increased from 0.39 cm2 preoperative to 0.78 cm2 postoperative (P<0.01). Meanwhile, the mean airflow velocity in the nasal valve area decreased from 6.19 m/s to 2.88 m/s (P<0.01). Surgical restoration of the nasal symmetry in the bilateral nasal cavity reduced nasal resistance in the narrow sides from 0.24 Pa.s/mL to 0.11 Pa.s/mL (P<0.01). Numerical simulation of the nasal cavity in patients with anterior nasal cavity stenosis revealed structural changes and the resultant patterns of nasal airflow. Surgery achieved balanced bilateral nasal ventilation and decreased nasal resistance in the narrow region of the nasal cavity. The correction of nasal valve stenosis is not only indispensable for reducing nasal resistance, but also the key to obtain satisfactory curative effect.

Autoespaciador en rinoplastía por técnica abierta y cerrada / Autospreader in rhinoplasty by open and closed approach

Introducción: La dificultad en el adecuado manejo del dorso nasal radica en su pérdida de soporte, razón por la cual el injerto espaciador (spreader graft) ocupa un lugar destacado en rinoplastía, proveyendo amplitud al techo dorsal, a la vez que incrementa el ángulo de la válvula nasal interna, generando una optimización en los resultados estéticos y funcionales de la cirugía nasal. El autoespaciador mantiene estos mismos principios, utilizando el propio cartílago lateral superior. Objetivo: Describir la técnica del autoespaciador, beneficios y la experiencia de los autores en 80 casos de pacientes sometidos a rinoplastía por abordaje abierto y cerrado. Material y método: Trabajo retrospectivo descriptivo, de los pacientes intervenidos quirúrgicamente por autor principal utilizando la técnica señalada. Resultados: Casuística de 80 pacientes, de los cuales 70% sexo femenino, siendo el promedio de edad 30 años. Abordaje abierto en el 50%. No se reportaron complicaciones intraoperatorias, no existieron obstrucciones anatómicas ni funcionales a nivel de la válvula nasal interna, así como tampoco deformaciones estéticas en "V" invertida tras un seguimiento reportando entre 6 y 24 meses. Conclusión: El autoespaciador al igual que el injerto espaciador clásico, previene problemas funcionales manteniendo el ancho del dorso nasal y optimizando el adecuado funcionamiento de la válvula interna, al tiempo que incrementa el éxito estético de la cirugía, pareciendo a los autores, más simple y fisiológico respecto a su predecesor, el injerto espaciador clásico.

Introduction: The difficulty in the proper handling of the nasal dorsum is its loss of support, hence the spreader graft plays an important role in rhinoplasty, providing width to the dorsal ceiling, while increasing the angle of internal nasal valve, generating an optimization in the aesthetic and functional results of nasal surgery. The autospreader maintains these same principles, using the upper lateral cartilage itself. Aim: To describe the technique of autospreader, benefits and the experience of the authors in a series of patients undergoing open and closed rhinoplasty approach. Material and method: A retrospective descriptive study of patients operated on by primary author using the indicated technique. Results: Casuistry of 80 patients, of whom 70% female, average age being 30 years. Open approach 50%. No intraoperative complications were reported, there were no anatomical or functional obstruction at the level of internal nasal valve, neither aesthetic deformities like inverted "V" after a follow reporting between 6 and 24 months. Conclusions: The autospreader, like the classic spreader graft prevents functional problems maintaining the width of the nasal dorsum and optimizing the proper functioning of the internal valve, while increasing the aesthetic success of surgery, seeming to authors more simple and physiological over its predecessor, the spreader graft.

A Practical and Clinical Application of the Septoplasty / 대한이비인후과학회지

A nasal septal deviation is a condition that should be handled as a disease entity only when a patient complaints intractable nasal stuffiness or decreased quality of life. Also a surgeon should diagnose a various cause of the nasal obstruction including static and dynamic collapse of the nasal valve. Although septoplasty is most commonly performed operation to relieve the nasal obstruction, it is sometimes very difficult and cumbersome because of a variety of septal pathology. A surgeon should be aware of the specific condition of patients and should apply the tailored techniques to correct each condition. This review could provide a detailed and practical information at each steps of the septoplasty, also gives various tips to remind at the operation room and outpatient clinic. Recent papers regarding septoplasty techniques, tips and pearls, complications are reviewed and my personal recommendations with tiny tips are provided also.

Surgery for Nasal Valve Compromise / 대한이비인후과학회지

The nasal valve spans a minimal cross sectional area of the intake point inside the nose. Acting as a Starling's resistor, it plays a pivotal role in controlling the inspiratory airflow. Nasal valve compromise, better known as nasal valve dysfunction, can be suspected when the patient complains of inspiratory nasal obstruction after trauma or surgery. If the patient has a history highly suspicious of nasal valve compromise, thorough physical examinations are mandatory in order to find the exact epicenter. The deformed L-strut septum and/or upper lateral cartilage are mainly responsible for the static internal nasal valve compromise. Characteristic findings include pinching of the middle vault and an inverted V deformity. Widening the nasal valve area is the most preferred therapy to correct statically narrowed nasal valve compromise. External valve compromise, on the other hand, is dynamically collapsible in many cases as evident during respiration. Typical sign, therefore, includes an inward collapse of alar and/or lateral wall upon inhalation. Treatment strategy, in this particular case, usually involves a cartilage addition to the deficient lateral wall or alar in order to stablize and provide rigidity to the lateral wall and also resist inspiratory negative force. However, surgeons should not be confused by the collapse as it may merely reflect the collapsibility of the structure rather than a genuine epicenter of nasal obstruction. Cartilage graft with or without suturing is the best therapeutic measure for patients with either static or dynamic nasal valve compromise when tackling nasal obstruction. It also enhances the structural integrity of the nasal valve. This review focuses on the various surgical techniques used in repairing nasal valve compromise to increase patency and restore breathing with an emphasis on each specific indication.

Lateral Nasal Valve Suspension: Nasal Valve Collapse with Facial Palsy / 대한이비인후과학회지

The nasal problems following facial paralysis could be due to nasal obstruction and asymmetric change of the mid face contour. They can occur because of the collapse in the alar sidewall of the adjacent soft tissue ptosis and the loss of intrinsic dilator naris tone. A number of procedures including face-lift are available to correct this problem. We present the case of a 52-year-old woman with unilateral nasal obstruction and mid face asymmetry after Bell's palsy. The site of nasal obstruction was nasal valve area that weakened secondary to facial paralysis. We used lateral suspension technique to correct nasal valve collapse by providing a lateral vector of pull on the nasal sidewall and nostril. Battery-operated Stryker drill and the Mitek drill bit were used for suspension. Immediately after operation, nasal obstruction and facial asymmetry were released. This procedure was simple and highly effective for correcting nasal valve collapse.

Puesta al día en manejo de la obstrucción nasal por colapso valvular / Update in nasal obstrucción management caused by valvular collapse

La estenosis de la válvula nasal aparece como una complicación frecuente de rinoplastfa o traumatismo nasal. Existen diferentes técnicas para corregir el colapso de la válvula nasal; generalmente se utilizan injertos de tejido, que en algunas ocasiones son insuficientes para resolverla alteración y mejorar la función respiratoria. La válvula nasal funciona en base a la resistencia de la ley Starling, que consiste en un tubo semirrígido con un segmento flexible; cuando la presión inspirada excede un nivel crítico, éste se colapsa y provoca la alteración en su fisiología; por tanto, es necesario cierto grado de rigidez en el componente lateral nasal para evitar el colapso durante la inspiración. Cuando se ve afectado su funcionamiento causa frecuentemente obstrucción nasal.

Nasal valve stenosis commonly presents as a postoperative complication of rhinoplasty or facial trauma. Various techniques have been reported to correct nasal valve stenosis through the use of methods that support the nasal valve with cartilage, rib graft, although these tissues are not useful in some cases to improve the nasal breathing. The nasal valve functions as the law Starling resistor, which is a semirigid tube with a flexible segment, when the inspired partial pressure exceeds a critical level, it collapses and causes nasal obstruction, and therefore need some degree of rigidity in nasal lateral component to avoid collapse during inspiration. When the nasal valve is affected frequently causes nasal obstruction.

Válvula nasal: anatomia e fisiologia: [revisão] / Nasal valve: anatomy and physiology: [review]

A porção anterior das cavidades nasais, da narina à válvula nasal (VN), é a região de maior resistência nasal ao fluxo aerífero, de suma importância para a fisiologia nasal. Na literatura existem terminologias diferentes para se referir às mesmas estruturas anatômicas e, ainda, o mesmo termo se referindo a estruturas anatômicas diferentes. OBJETIVO: Realizamos este trabalho com o objetivo de revisarmos o funcionamento da VN e definirmos com mais clareza estruturas anatômicas da porção anterior das cavidades nasais, principalmente a região da VN. CONCLUSÃO: Existe controvérsia na literatura quanto à nomenclatura das estruturas da VN. Neste trabalho definimos VN como uma estrutura tridimensional compreendida anteriormente pelo ostium internum e posteriormente pelo isthmus nasi.

The anterior portion of the nasal cavities, from the nostril to the nasal valve (NV), is the place of highest nasal resistance to airflow, paramount to nasal physiology. There are different terminologies for the same anatomic structures in the literature. AIM: The aim of this paper was to study the NV function and define clearly the structures of the anterior portion of the nasal cavities, mainly the region of the NV. CONCLUSION: Internum ostium is the anterior segment and isthmus nasi is the posterior segment of the NV region.

Correction of Internal Nasal Valve Obstruction Induced by Posttraunmatic Scar Constriction: A Case Report

The borders of the internal nasal valve are defined by the caudal edge of the upper lateral cartilage supero-laterally, the cartilaginous septum medially, and the nostril floor inferiorly. It is the narrowest portion of the nasal airway and one of the primary regulator of nasal air flow. internal nasal valve collapse is a serious problem associated with prior nasal surgery, previous trauma, aging, or primary weakness of the upper lateral cartilage. We report a case of the internal nasal valve obstruction due to an uncommon mucocutaneous scarring. A 55-year-old male patient complained of headache, severe nocturnal snoring and unilateral nasal obstruction. He had a linear depressed 1.5cm in length scar on the nose dorsum, caused by a lacerated wound. The intranasal examination revealed a concentric narrowing of the left internal nasal valve area by mucocutaneous scar constriction and a left sided septal deviation, but inferior turbinate hypertrophy was not seen. After an open rhinoplasty incision, the nasal airway obstruction was relieved by scar release with the five flap Z-plasty, submucosal resection of deviated septal cartilage and unilateral spreader graft using autogenous septal cartilage. He was pleased with a significant relief of nasal obstructive symptoms. The cross- sectional size of the internal nasal valve area was maintained until postoperative 8 months. Correction of internal nasal valve obstruction must involve surgery on all the structures that make up the valve: septum, upper and lower lateral cartilage, intranasal mucosa, and the inferior turbinate.

Treatment of the Nasal Valve Stenosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal obstruction is most often caused by the problems in the nasal valves which are located in the anterior part of the nose. Without careful evaluation of this part of the nose, the effort to improve nasal breathing may be fruitless. However, relatively little attention has been paid to the nasal valve problems. In the present study, we investigated the causes that underlie various problems in the nasal valve and looked for treatment procedures. MATERIALS AND METHODS: A total of 20 patients who had nasal obstruction due to valve problems were studied retrospectively. Various surgical procedures such as spreader graft, alar batten graft, auricular composite graft and Z-plasty were performed for the patients. RESULTS: All patients have experienced reduction in the nasal obstruction. Also, the widening of the valve area was observed. CONCLUSION: Surgery of the internal or external nasal valve is a key factor in functional rhinoplasty. It can significantly improve the nasal breathing of patients with nasal dysfunction leading to obstruction, insufficiency, and nasal valve collapse. With proper diagnosis of the problem, various surgical maneuvers can be used to repair a damaged valve and to correct breathing problems.

Measurement of the so-called "Nasal Valve" in Japanese Subjects

Because Mongoloids have been considered to have a wider nasal valve angle than Caucasians, fewer Japanese patients experience nasal obstruction due to stenotic nasal valve. However, there have been no studies measuring the nasal valve angle of Mongoloids. Accordingly, one aim of this study is to measure the nasal valve angle in Japanese subjects and obtain its standard value. Another aim is to measure the cross-sectional area at the nasal valve area. One hundred and sixteen healthy adult Japanese volunteers showing no symptoms or histories of nasal disease participated in this study. Each subject's nose was scanned, by endoscopy, and images of the subjects' nasal valve area were recorded using a video camera. The nasal valve angle was measured in video-printed photographs. Acoustic rhinometry was performed in each case. The subject's mean nasal valve angle was 28.9+/-6.3 degree, ranging from 16 to 45. The mean cross-sectional area at the I-notch was 0.95+/-0.16 cm2 . No relationship was found between the nasal valve angle and the cross-sectional area around the valve.