Surgery for the dysfunctional nasal valve. Cadaveric analysis and clinical outcomes.

OBJECTIVES To quantify changes in the cross-sectional area of the nasal valve after placement of spreader grafts and flaring sutures and to review clinical outcomes after nasal valve surgery. DESIGN The minimal cross-sectional area of cadaveric nasal valves was measured after placement of spreader grafts and flaring sutures. Clinical outcomes for patients undergoing functional rhinoplasty were retrospectively reviewed. SETTING Academic medical center. SUBJECTS Six fresh cadaver heads and a review of patients from September 1994 through May 1998. INTERVENTION Acoustic rhinometry was performed after placement of spreader grafts, flaring sutures, and the two together. Clinically, a site-specific repair was performed with spreader grafts and flaring sutures for statically narrowed internal nasal valves and cartilaginous battens for dynamic collapse. MAIN OUTCOME MEASURE Cross-sectional areas of cadaveric valves. Functional and aesthetic results were determined by nasal patency scores from 1 (complete obstruction) to 10 (complete patency) and a rating of postsurgical cosmetic changes. RESULTS Spreader grafts improved the cadaveric minimal cross-sectional areas by 5.4% (P > .05), flaring sutures by 9.1% (P > .05), and spreader grafts combined with flaring sutures by 18.7% (P < .05). Mean nasal patency scores improved from 3.4 to 6.5 (P < .01) with the combination of spreader grafts and flaring sutures. Cartilaginous battens improved scores from 2.7 to 6.3 (P < .01). CONCLUSIONS The combination of flaring sutures and spreader grafts has the greatest impact on the cadaveric nasal airway. Either technique alone failed to have a statistically significant impact on the minimal cross-sectional area of the nasal valve. Clinical review confirms significant improvement in nasal function using this combination technique.