Minimally Invasive Nasal Valve Treatment

Abstract

The objective of this article is to explore minimally invasive techniques to treat a poorly functioning nasal valve. It reviews the literature to introduce anatomy and examination, detail efficacy, instruct procedural protocols, and summarize utility. The article was composed based upon literature review and expert opinion. Nasal obstruction is a frequent problem managed by the facial plastic surgeon. It can occur at multiple sites, but commonly problematic regions are the nasal valves. A comprehensive nasal exam can elucidate the source of obstruction and validated obstruction measurements, such as the Nasal Obstruction Symptom Evaluation Instrument or the Standardized Cosmesis and Health Nasal Outcomes Survey for Functional and Cosmetic Rhinoplasty, can classify severity. Cartilage grafting and open septorhinoplasty techniques are invaluable for correcting nasal valve obstruction; however, the traditional methods may be neither possible nor optimal for all patients. Minimally invasive treatment modalities have emerged to offer an alternative to classical treatment algorithms. Minimally invasive techniques aimed at improving the nasal valve function include nasal dilators, suture suspension, lateral nasal wall bioresorbable implants, and cartilaginous radio frequency remodeling. Benefits of these methods include clinic-based intervention, avoidance of general anesthesia, use in previously operated noses, and minimally invasive nature. Publications with ranging levels of evidence support the efficacy of these interventions when patients with isolated nasal valve obstruction are examined. Limitations in the data, such as study power, source of funding, duration of follow-up, and longevity of response, warrant the need for further investigation; however, the efficacy of these techniques justifies implementation in proper patient populations into current practice. Minimally invasive nasal valve correction is a valuable tool in the armamentarium of the facial plastic surgeon. It cannot and should not replace traditional septorhinoplasty; however, the techniques are a valuable consideration for the appropriate patient population.

Keywords

nasal valve - nasal dilators - suture suspension - lateral nasal wall implant - radio frequency remodeling

Publication History

Accepted Manuscript online:
11 May 2022

Article published online:
07 August 2022

• References

• 1 Hamilton III GS. The external nasal valve. Facial Plast Surg Clin North Am 2017; 25 (02) 179-194
• 2 Hsu DW, Suh JD. Anatomy and physiology of nasal obstruction. Otolaryngol Clin North Am 2018; 51 (05) 853-865
• 3 Kridel R, Sturm A. The nasal septum. In: Flint P, Francis H, Haughey B. et al., eds. Cummings Otolaryngology Head and Neck Surgery. 7th ed.. Philadelphia: Elsevier Inc; 2021: 442-444
• 4 Samra S, Steitz JT, Hajnas N, Toriumi DM. Surgical management of nasal valve collapse. Otolaryngol Clin North Am 2018; 51 (05) 929-944
• 5 Costa DJ, Sanford T, Janney C, Cooper M, Sindwani R. Radiographic and anatomic characterization of the nasal septal swell body. Arch Otolaryngol Head Neck Surg 2010; 136 (11) 1107-1110
• 6 Meng X, Zhu G. Nasal septal swell body: a distinctive structure in the nasal cavity. Ear Nose Throat J 2021; (e-Pub ahead of print) DOI: 10.1177/01455613211010093.
• 7 Catalano P, Ashmead MG, Carlson D. Radiofrequency ablation of septal swell body. Ann Otolaryngol Rhinol. 2015; 2 (11) 1069
• 8 Tsao GJ, Fijalkowski N, Most SP. Validation of a grading system for lateral nasal wall insufficiency. Allergy Rhinol (Providence) 2013; 4 (02) e66-e68
• 9 Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the nasal obstruction symptom evaluation (NOSE) scale. Otolaryngol Head Neck Surg 2004; 130 (02) 157-163
• 10 Lipan MJ, Most SP. Development of a severity classification system for subjective nasal obstruction. JAMA Facial Plast Surg 2013; 15 (05) 358-361
• 11 Moubayed SP, Ioannidis JPA, Saltychev M, Most SP. The 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) for functional and cosmetic rhinoplasty. JAMA Facial Plast Surg 2018; 20 (01) 37-42
• 12 Patel PN, Wadhwa H, Okland T, Kandathil CK, Most SP. Comparison of the distribution of standardized cosmesis and health nasal outcomes survey scores between symptomatic and asymptomatic patients. Facial Plast Surg Aesthet Med 2021; 0 (00) 1-5
• 13 Kirkness JP, Wheatley JR, Amis TC. Nasal airflow dynamics: mechanisms and responses associated with an external nasal dilator strip. Eur Respir J 2000; 15 (05) 929-936
• 14 Lekakis G, Dekimpe E, Steelant B, Hellings PW. Managing nasal valve compromise patients with nasal dilators: objective vs. subjective parameters. Rhinology 2016; 54 (04) 348-354
• 15 Paniello RC. Nasal valve suspension. An effective treatment for nasal valve collapse. Arch Otolaryngol Head Neck Surg 1996; 122 (12) 1342-1346
• 16 Friedman M, Ibrahim H, Syed Z. Nasal valve suspension: an improved, simplified technique for nasal valve collapse. Laryngoscope 2003; 113 (02) 381-385
• 17 Friedman M, Ibrahim H, Lee G, Joseph NJ. A simplified technique for airway correction at the nasal valve area. Otolaryngol Head Neck Surg 2004; 131 (04) 519-524
• 18 Nuara MJ, Mobley SR. Nasal valve suspension revisited. Laryngoscope 2007; 117 (12) 2100-2106
• 19 Rippy MK, Baron S, Rosenthal M, Senior BA. Evaluation of absorbable PLA nasal implants in an ovine model. Laryngoscope Investig Otolaryngol 2018; 3 (03) 156-161
• 20 San Nicoló M, Stelter K, Sadick H, Bas M, Berghaus A. Absorbable implant to treat nasal valve collapse. Facial Plast Surg 2017; 33 (02) 233-240
• 21 San Nicoló M, Stelter K, Sadick H, Bas M, Berghaus A. A 2-year follow-up study of an absorbable implant to treat nasal valve collapse. Facial Plast Surg 2018; 34 (05) 545-550
• 22 Stolovitzky P, Sidle DM, Ow RA, Nachlas NE, Most SP. A prospective study for treatment of nasal valve collapse due to lateral wall insufficiency: outcomes using a bioabsorbable implant. Laryngoscope 2018; 128 (11) 2483-2489
• 23 Seren E. A new surgical method of dynamic nasal valve collapse. Arch Otolaryngol Head Neck Surg 2009; 135 (10) 1010-1014
• 24 Jacobowitz O, Driver M, Ephrat M. In-office treatment of nasal valve obstruction using a novel, bipolar radiofrequency device. Laryngoscope Investig Otolaryngol 2019; 4 (02) 211-217
• 25 Zemek AJ, Protsenko DE, Wong BJF. Mechanical properties of porcine cartilage after uniform RF heating. Lasers Surg Med 2012; 44 (07) 572-579
• 26 Ephrat M, Jacobowitz O, Driver M. Quality-of-life impact after in-office treatment of nasal valve obstruction with a radiofrequency device: 2-year results from a multicenter, prospective clinical trial. Int Forum Allergy Rhinol 2021; 11 (04) 755-765
• 27 Silvers SL, Rosenthal JN, McDuffie CM, Yen DM, Han JK. Temperature-controlled radiofrequency device treatment of the nasal valve for nasal airway obstruction: A randomized controlled trial. Int Forum Allergy Rhinol 2021; 11 (12) 1676-1684
• 28 Bikhazi N, Ow RA, O'Malley EM, Perkins N, Sidle DM, Stolovitzky P. Long-term follow-up from the treatment and crossover arms of a randomized controlled trial of an absorbable nasal implant for dynamic nasal valve collapse. Facial Plast Surg 2021; (e-Pub ahead of print) DOI: 10.1055/s-0041-1740948.