External nasal valve dysfunction is known to be a common cause of nasal obstruction. The authors present a prospective case series (n=19) including primary and revision cases of functional rhinoplasties. All patients reported nasal obstruction and were diagnosed with external nasal valve dysfunction.
Subjective estimation of patients’ nasal breathing was documented by using visual analogue scales, completion of the validated Nasal Obstruction Symptom Evaluation (NOSE) Scale, the 22-Item Sinonasal Outcome test (SNOT-22), and the 36-Item Short From Health Survey, version 2 (SF-36v2). For objective assessment the authors measured nasal peak inspiratory flow, nasal airway resistance, minimum cross-section area. The functional reconstructive rhinoplasties were based on lateral crural turn-in in cases of primary intervention or lateral crural strut grafts using costal cartilage revision procedures. Postoperatively, Palsey et al. documented a significant improvement in the patient-related outcome measures. General quality of life improved but did not show statistical significance. Objective assessment of airflow showed variable changes that were all insignificant. The presented results are in accordance to Rhee’s clinical consensus statement in which patient-reported outcome measures were more important than objective outcome measures. Palsey and coworkers observed a reduced collapsibility of the airway as documented by improvement of peakflow and symptoms. Contrary to common belief surgical interventions did not change the airway in size or resistance during normal breathing. Therefore they assume that the increase of lateral nasal wall rigidity is the key to the presented improvements.

Airflow and patient-perceived improvement following rhinoplastic correction of external nasal valve dysfunction.
Palesy T, Pratt E, Mrad N, et al.
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Gregor M Bran

Dr Horst Schmidt Kliniken, Wiesbaden, Germany.

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