Surgery of the nasal valve is a particularly challenging aspect of functional rhinoplasty surgery. The nasal valve area represents the segment with the smallest cross-sectional diameter of the entire airway. The authors of this article present a novel method to optimise the stability of the nasal valve during inspiration. The stairstep graft is based on the principle of an alar strut graft. It is placed underneath the lower lateral crus and its lateral extend is positioned onto the piriform crest. In order to achieve additional increase in the basal width of the nasal valve area, one or more interpositional grafts are fixated underneath the lateral end of the graft, resting on the piriform crest. Gassner et al. present their clinical results based on eight consecutive patients with a diagnosis of nasal valve collapse that were included in this study. Postoperative evaluation included photography and questionnaires. A minimum follow-up of three months revealed an improvement of nasal airway in all patients and persistent normalisation of the preoperatively narrow alar base was noted. The authors define the following surgical details to be of paramount importance for a successful application of this new technique: transection of the piriform ligaments, wide undermining of the soft-tissue insertions along the piriform crest, and lateralisation of the alar strut graft with a structural graft that has been sutured to the first and positioned on the piriform crest.

The stairstep graft – an alternative technique in nasal valve surgery.
Gassner H, Maneschi P, Haubner F.
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Gregor M Bran

Dr Horst Schmidt Kliniken, Wiesbaden, Germany.

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