The Alar Extension Graft Technique for the Treatment of External Nasal Valve Collapse: Preliminary Results of a Single-Centre Prospective Analysis.

BACKGROUND: The aim of this study is to describe the efficacy of the alar extension graft for the correction of external nasal valve collapse and to evaluate the functional and aesthetic results. METHODS: The study included 51 patients who underwent alar extension grafting for external nasal valve collapse. Pre- and post-operative rhinomanometry was performed before and after surgery. NOSE and SNOT 20 questionnaires were completed before and 9 months after surgery. Patients were also asked about their post-operative satisfaction. RESULTS: 90% of patients were subjectively satisfied with the post-operative improvement in nasal breathing. There was a significant improvement in the values of the pre- and post-operative NOSE and SNOT 20 questionnaire scores. Rhinomanometry showed increased nasal flow with a statistically significant difference between pre- and post-operative results. CONCLUSIONS: The alar extension graft has been proved to be effective and reliable in the surgical treatment of external nasal valve collapse, improving the patients' objective and subjective breathing with good functional and aesthetic results. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

"Supratip Cross Flap: Reshaping the Nasal Tip and Improving the Nasal Vault Function."

The authors propose a novel flap for rhinoplasty: the supratip cross flap (SCF). It is a simple and effective method for avoiding and correcting alar contour deformities and external nasal valve (ENV) issues in rhinoplasty without grafts. In addition to its benefit for supratip break, the flap also allows a smooth and natural transition between the nasal dorsum and the nasal tip complex.

The Comprehensive Evaluation of the Pinch Deformity due to Concave Alar Cartilages and Its Management.

INTRODUCTION: Acute angle between dome and ala causes alar concavity/pinch deformity. Breathing problems may accompany pinching. Here, pinch deformities were classified according to their severity and treatment modalities discussed. MATERIALS AND METHODS: Rhinoplasty patients with pinch deformities were included in study. Pinching without external nasal valve blockage (ENVB) was classified mild, pinching with ENVB was classified moderate, and extreme pinching and ENVB were classified severe deformity. In mild deformity, cephalic resection of ala was performed or cephalic resection was combined with onlay graft over ala. In moderate deformity, cephalic part was bent and sutured over lower ala. In severe deformity, cephalic part was bent, and lateral strut graft was inserted between lower and cephalic ala. In pinch deformities combined with hypertrophic lower lateral cartilage (LLC), medial crural overlay preceded above-mentioned treatment modalities. RESULTS: Thirty-eight patients (22 female, 16 male) with pinch deformities underwent rhinoplasty between January 2017 and December 2022. Mean age was 27 years. Mean follow-up was 32 months. Fifteen patients had mild deformities. Cephalic resection was enough in four patients. Camouflage grafts were settled over ala in eleven patients. Twenty patients had moderate deformities; cephalic ala was bent over lower part and sutured. Two patients had severe deformities; lateral strut graft was settled between lower and bent cephalic alar parts. One patient had LLC hypertrophy/pinch deformity. LLC hypertrophy was corrected by medial crural overlay, and concavity was corrected with cephalic resection. Satisfactory shape, better valve passage obtained in all cases. CONCLUSION: Pinch deformity could be classified according to its severity and appropriate treatment options could be determined for each class. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/journal/00266 .

Surgical correction of the lower lateral cartilage protrusion and external nasal valve pinching with lateral crural resection technique.

OBJECTIVE: The aim of this study is to demonstrate a novel surgical technique in the treatment of lower lateral crural protrusion and external nasal valve pinching. METHOD: The lower lateral crural resection technique was used in 24 patients who underwent open technique septorhinoplasty between 2019 and 2022. Fourteen of the patients were female and 10 were male. In this technique, excess part of crura's tail was excised from the lower lateral crura and placed in the same pocket. This area was supported with a diced cartilage and a postoperative nasal retainer was applied. We have corrected the aesthetic problem that occurs when the lower lateral cartilage is convex, and external nasal valve pinching that occurs when the lower lateral crural protrusion is concave. RESULT: The mean age of the patients was 23. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery. CONCLUSION: A new surgical approach has been proposed for patients with lower lateral crural protrusion and external nasal valve pinching using the lateral crural resection technique.

Effect of Lateral Crural Procedures on Nasal Wall Stability and Tip Aesthetics in Rhinoplasty.

OBJECTIVES/HYPOTHESIS: To evaluate the lateral nasal wall stability, nasal function, and cosmesis when creating an aesthetically pleasing nasal tip subunit utilizing lateral crus (LC) altering procedures. STUDY DESIGN: Retrospective cohort. METHODS: In this retrospective cohort study, cosmetic rhinoplasty patients undergoing LC procedures with available lateral wall insufficiency (LWI) scores were included. An LWI grading system was used to evaluate internal (zone 1) and external (zone 2) nasal valves objectively. Secondarily, Nasal Obstruction Symptom Evaluation (NOSE) Score, Visual Analog Scale (VAS) and Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) results were evaluated. Based on the LC intervention, the cohort was divided into six groups: lateral cural strut graft (LCSG), mini-LCSG, lateral crural overlay (LCO) with and without additional support, cephalic trimming, and cephalic turn-in flaps. RESULTS: Subjects undergoing LCO with and without support, LCSG, and mini-LCSG showed significant improvement in zone 1 LWI (P = .042, P = .041, P < .001, and P < .001, respectively), while cephalic trimming and turn-in/hinged flaps had no effect. Subjects undergoing LCO with support and LCSG showed significant improvement in zone 2 LWI (P = .022, P = .004), while LCO without support, mini-LCSG, cephalic trimming, and turn-in flaps showed no effect on LWI. The SCHNOS-C and VAS-C showed significant improvement in all subgroups (P < .05) when comparing pre- to postoperative values. Alar-spanning sutures did not significantly change zone 1 scores but did conceal zone 2 improvements in LCSG and LCO with support groups. CONCLUSIONS: Selected LC procedures are robust techniques for improving tip cosmesis independently without compromising nasal lateral wall stability. Some LC procedures can improve nasal valves patency in tip surgery. Laryngoscope, 131:E1830-E1837, 2021.

Correction of Septal Perforation/Nasal Airway Repair.

Rhinoplasty is a double-edged sword regarding the functional nasal airway; it can enhance and improve the nasal airway if done properly, and can severely compromise the nasal airway if not done properly. The composition of the nasal airway includes the internal and external nasal valves, nasal septum, and inferior turbinates. Each of these areas can be addressed by several techniques, described in the body of the text. Nasal septal perforation is another potential complication that may result from septal surgery, which has nonsurgical and surgical methods to treat, and is also described in the body of the text.

Turn-in Flap: 10 Years' Experience of a Single Institution in Saudi Arabia.

Background and objective Cephalic excision of the lateral crus is the most used procedure in rhinoplasty when attempting to make the nasal tip smaller or narrower to improve the definition. However, due to its several drawbacks as external valve collapse, bossae formation, and alar retraction, a technique, known as the Turn-in flap, has been developed to overcome these complications and to provide better aesthetic and functional nasal tip outcomes. Therefore, we conducted this investigation to determine the long-term outcomes of such procedure. Methods During the period from 2007 to 2017, the charts of 120 patients who underwent the Turn-in flap procedure at King Saud University have been reviewed. The study included 42 males and 78 females with a mean age of 23 years. The follow-up duration ranged from one to 10 years with a mean duration of two years. Results The majority (30%) of our patients underwent Turn-in flap procedure due to combined lower lateral cartilage (LLC) convexity and bulbous tip. Satisfactory results have been observed in most cases with no post-operative complications. Only six cases required revision surgery. Conclusions The Turn-in folding of the cephalic part of lateral crus does not only provide functional support to the nose, but it also provides aesthetic improvement of the nasal tip with long-term satisfactory outcomes.

[External nasal valve. Method of reconstruction with its dysfunction]. / Sposob rekonstruktsii naruzhnogo nosovogo klapana.

The aim of this work is to improve the reconstruction techniques the external nasal valve, with its dysfunction caused by vertically located lateral legs of the lower lateral cartilage. There is shown a brief analysis of the anatomy of the external and internal nasal valve, methods of reconstruction with its dysfunction and surgical correction of this. The method of reconstruction of the external nasal valve is proposed, where we have used the isolation and removal of the vertically extending lateral legs lower lateral cartilage and expansion of the valve zone by an auto / allogeneic cartilaginous graft. The advantages and disadvantages of the proposed method are estimated.

Management of Long-Standing Flaccid Facial Palsy: Static Approaches to the Brow, Midface, and Lower Lip.

Chronic flaccid facial paralysis (FFP>2 years) may be approached with static and dynamic techniques. A horizontal zonal assessment evaluates the upper, middle, and lower thirds of the face. Surgery is tailored to an individual's deficits, goals, and health status. While dynamic reanimation is the gold standard for rehabilitation, there are cases in which static approaches are more appropriate or may be used as an adjunct to dynamic techniques. This article focuses on the surgical management of FFP primarily using static approaches to the individual zones of the face to create resting symmetry.

Surgical Management of Nasal Valve Collapse.

Nasal valve collapse has multiple causes, including congenital, traumatic, and, unfortunately, iatrogenic. Recognition of the causes of nasal valve collapse and the methodology for treatment is paramount not only for the otolaryngologist but also for any physician managing the nasal airway. This article focuses on the cause and surgical management of internal and external nasal valve collapse.

Nasal Obstruction Considerations in Cosmetic Rhinoplasty.

Cosmetic rhinoplasty is an increasingly popular procedure in the United States. There are critical aspects of preoperative planning and intraoperative execution that facilitate successful rhinoplasty. Thorough preoperative assessment of the structures comprising the internal and external nasal valves and identification of potential at-risk areas for static or dynamic compromise must be done before surgery. Thoughtful maneuvers and meticulous surgical technique must be used. Postoperative counseling ranges from simple reassurance to medical therapy to procedural efforts to alleviate a patient's concerns. It is important to establish rapport with the patient and dutifully address all cosmetic and functional concerns.

External Nasal Valve Repair in Children: Alar Batten Graft Reinforced by External Temporary Suspensory Suture.

BACKGROUND: The nasal valve area is the narrowest point in the nasal airway. External nasal valve (ENV) collapse during inspiration occurs if external valve area is too narrow or its lateral component is too floppy. PATIENTS AND METHOD: Twelve patients (7 males, 5 females) aged 8 to 12 years complaining of nasal obstruction due to ENV dysfunction underwent surgical intervention using alar batten graft assisted by temporary external suspensory suture. RESULTS: All patients showed subjective and objective improvement of the nasal airway. The mean Nasal Obstructive Symptom Evaluation (NOSE) was 14 ± 1.71 before surgery and 7.83 ± 1.47 1 year after surgery (significant improvement, p ≤ .0001). The mean Peak Inspiratory Flow Rate was 29.92 ± 4.46 before surgery and 42.58 ± 4.93 1 year after surgery (significant improvement, P ≤ .0001). CONCLUSION: External nasal valve collapse in children can be managed surgically by using alar batten graft. Temporary suspension suture can be helpful for supporting of the graft until complete healing occurs.

Treatment Paradigm for Nasal Airway Obstruction.

Nasal airway obstruction (NAO) is a common otolaryngic complaint with many potential causes, frequently structural or inflammatory in nature. Patients typically have multiple coexisting factors leading to symptoms. Good patient outcomes require careful preoperative evaluation, including nasal endoscopy, to accurately identify sources of obstruction and tailor intervention appropriately. Common structural causes of NAO include inferior turbinate hypertrophy, nasal septal deviation, and narrowing or collapse of the internal or external nasal valves. The internal nasal valve has the narrowest cross-sectional area within the nasal airway and is thus most sensitive to changes in dimension due to anatomic variation or surgical intervention.

The External Nasal Valve.

The external nasal valve is a complex entity comprised of multiple structures and tissue types. As such, there is no single operation that can address all problems of the external valve. This article reviews the relevant anatomy, pathologic conditions, and treatments for external nasal valve dysfunction, including a detailed review of the nasal muscles and their contribution to external nasal valve patency. Surgical and nonsurgical options for treatment and the evidence supporting the importance of proper external nasal valve function on quality-of-life measures are discussed.

Prosthetic Rehabilitation of Bilateral External Nasal Valve Area after Nasal Reconstruction for a Congenitally Missing Nose: A Clinical Report.

Deformities of the nostrils and alar region are among the very common clinically defects, which interfere with the functional anatomy of the nose. This case paper exemplifies the management of a bilateral external nasal valve area defect in a patient following a nasal reconstruction done using a forehead flap. The nasal stents were rendered to the patient for comfortable breathing by maintaining patency of the nasal passage after the surgical procedure and also improve speech and esthetics.

External Nasal Valve Efficacy Index: a simple test to evaluate the external nasal valve.

Many methods and techniques have been proposed for the assessment of the nasal valve, most requiring special equipment. Furthermore the main focus has been on the internal valve, while the role of the external nasal valve (ENV) has usually been underestimated. An index to assess ENV is presented herein. Two photographs of the basal view of the nose are taken, one in the resting position and the other after deep inspiration. These two life-size views are used to calculate the External Nasal Valve Efficacy Index (ENVE Index). Using simple software, the surface area of the nostril in the resting view (A) and breathing view (B) is measured. The ENVE Index is calculated by dividing the deep inspiration surface area by the resting surface area (B/A). The clinical indications for the use of the ENVE Index include rhinoplasty treatment planning, postoperative evaluation to assess the effects of surgery with regard to improvement or deterioration of the airway, and orthognathic surgery and the planning of appropriate postoperative care (such as elastic or intermaxillary fixation) according to the airway patency. The ENVE Index is a relatively simple, reproducible, and documentable test. This index can help the surgeon to make better decisions during treatment planning and postoperative care.