Techniques for the improvement of the internal nasal valve in functional-cosmetic nasal surgery

The internal nasal valve (INV) refers to the slit-like region between the c audal end of the upper lateral cartilage (ULC) and the nasal septum. It is the narrowest portion and primary regulator of the nasal airway. Reduction rhinoplasty decreases the nasal airway cross-sectional area and may cause s ymptoms, unless additional surgical measures are taken. Rhinoplasty or sept orhinoplasty was performed for 76 patients with a nasal hump. using an exte rnal approach. As a consequence of the nasal hump removal, the ULCs were se parated from the septal cartilage. All patients underwent one of the three forms of cartilaginous nasal dorsum reconstruction: primary closure (PC) (5 0 patients); spreader graft (SG) (19 patients): or upper lateral splay graf t (ULSG) (7 patients). ht least 3 months postoperatively, INV obstruction w as evaluated by asking the patients about nasal obstruction symptoms and vi sually examining the INV with an otoscope. Nasal obstruction complaints and INV constriction found among patients in the PC. SG and ULSG groups were 1 6 (32%). 2 (10.5%) and none, respectively. The results of the PC group were compared statistically with the combined results of the SG and the ULSG gr oups. The patients in the combined SG-ULSG group had significantly less nas al obstruction complaints and INV angle constriction compared with the PC g roup. Due to the higher rate of postoperative INV stenosis, PC should be av oided. The author uses ULSG when the septal cartilage appears straight and sturdy and SGs when the straightened septal cartilage looks weak and vulner able. since SGs not only improve the INV, but also reinforce the septal car tilage.