Outcome of Nasal Valve Obstruction After Functional and Aesthetic-Functional Rhinoplasty

Overview

The nasal valve is the narrow, flexible part of the airway that can collapse on breathing in, and it is a distinct cause of blockage from a bent septum or swollen turbinates. Rebuilding it uses spreader and alar grafts. Many patients also want appearance changes. This prospective multicentre study asked whether combining the two affects the breathing result.

Sections of note

• Prospective multicentre cohort study, 12 participating surgeons, 79 consecutive patients with nasal valve insufficiency as the primary cause of obstruction.
• Data were collected from March 2006 to September 2008 and analysed in 2009 and 2013.
• 31 patients had functional rhinoplasty alone and 48 had combined aesthetic-functional rhinoplasty.
• Breathing was measured with the Nasal Obstruction Symptom Evaluation scale, 0 to 100, where higher means worse, at baseline and at 3, 6 and 12 months.
• Mean baseline score was 67.1. At three months the mean fell by 48.6 points, 95 percent confidence interval 41.9 to 55.2, p less than 0.001.
• Improvement was similar in both groups: 51.4 points functional, 46.6 points aesthetic-functional, p = 0.49. Level of evidence 2.

What it means for a patient

• Rebuilding the nasal valve with cartilage grafts produced a large improvement in how blocked patients felt.
• Having appearance work done at the same time did not reduce the breathing benefit.
• Results came from 12 surgeons at multiple centres rather than one practice, which makes them more likely to generalise.
• There was no untreated comparison group, so improvement over doing nothing cannot be separated from the natural course, and the abstract reports only the three-month comparison in detail.

Why this paper matters

Patients are sometimes told that combining cosmetic and functional goals compromises the breathing result. This study found no such penalty, using a validated symptom scale across many surgeons. What it does not resolve is how the improvement holds beyond twelve months.

Terms

• Nasal valve: the narrowest part of the nasal airway, which can collapse on breathing in.
• Nasal valve insufficiency: weakness or collapse of that area causing blocked breathing.
• Spreader graft: a narrow cartilage strip placed alongside the septum to hold the airway open.
• Alar graft: cartilage placed in the nostril rim area to support it against collapse.
• NOSE scale: a validated questionnaire scoring nasal obstruction from 0 to 100.