Nasal Valve Collapse: A Multifactorial Approach. Review of 100 Consecutive Patients
Nasal valve obstruction, both internal and external, has become increasingly recognized as a significant component of nasal airway obstruction in both revision rhinoplasty and the previously unoperated nose. Other causes of nasal airway obstruction are often associated with nasal valve obstruction including septal deviation and turbinate hypertrophy. The goal of the present study was to review our experience in the surgical management of nasal valve obstruction, and in particular to determine how often a multimodal approach was required to successfully eliminate nasal airway obstruction.
Methods/Technique:
A retrospective chart review of one hundred consecutive patients undergoing nasal valve surgery were reviewed from July 2009 to May 2013 with a minimum of 5 months follow up. Charts were reviewed and data collected including demographic information, etiology(ies), surgical procedure(s), complications and revisions.
Results/Complications:
Of the 100 patients , there were 74 cases of internal nasal valve collapse, 7 cases of external nasal valve collapse, and 19 patients with combined internal and external nasal valve collapse. A history of previous, although undocumented nasal trauma, was reported in 35 patients. A previous history of nasal surgery was reported in 45 patients. Spreader grafts were placed in 90 patients (90%), alar batten grafts in 18 patients (18%), other cartilage grafts in 23 patients (23%). A septoplasty was performed in 84 patients (84%), turbinate reduction in 78 patients (78%), and 92 patients had either septoplasty and/or turbinate reduction along with nasal valve surgery. Complications occurred in 17% of patients, including residual internal or external nasal valve collapse (11%), persistent septal deviation (4%) and infection (3%). Eight patients (8%) underwent further revision surgery.
Conclusion:
Nasal airway obstruction with nasal valve collapse is frequently associated with other etiologies of nasal airway obstruction, most commonly septal deviation and turbinate hypertrophy. Successful management of these patients requires a multimodal approach.