Minor Surgical Procedures for treating nasal valve collapse (NVC)

  A  variety of literature on minor surgical  procedures happens to exist claiming high efficacy for those suffering with nasal valve collapse. But chances are you  never heard about most of them. Some of the specific procedures are used in conjunction with other surgical grafting procedures, but a number of studies have shown that these procedures exclusive to other procedures can stand on their own for remedying NVC  for certain individuals that are diagnosed correctly.  They don't involve major grafting of the nose, or any in most cases, relatively not intricate and can take anywhere from 1-2 hours to complete,  could be covered by insurance or Government health care system, can improve nose aesthetically or remain about the same,  and very minimal down time. Caution:  Nasal valve collapse is a multidimensional problem. In some patients, the reduced cross-sectional area or an acute valve angle of less than 10° is the main problem. In others, the weak nasal sidewall plays a major role. In some patients, a combination of factors exists.Consequently, because most of these procedures focuses on only 1 factor, none is universal for every situation.

I will divide some of these procedures as follows: Plasty techniques, Suture techniques, Lateral crura options, butterfly grafts and synthetic injectable  grafts. I plan to discuss most if not all in more detail in upcoming posts.

Here's a list of  minor procedures for improving NVC.

Suture Techniques

• Flaring Sutures
• Nasal Valve Suspension

http://chicagoent.com/wp-content/uploads/nasalvalvesuspension.pdf

 Plasty Techniques 

• M-Plasty technique
• Z Plasty technique

http://www.tantamsj.com/jan2007/30-1-2007.pdf
http://archfaci.ama-assn.org/content/10/3/164.full.pdf

Butterfly grafts

• autologous grafts from ear
• Titanium expanded polytetrafluoroethlene e-PTFE

http://www.nc-faces.com/the-butterfly-graft/
http://archfaci.ama-assn.org/content/8/2/98.full.pdf

Alar Expansion and Reinforcement technique 
http://archfaci.ama-assn.org/content/8/5/293.full.pdf+html 

Lateral crura options    (Some of these graft procedures are performed together or in combination with other procedures and therefore considered Major Nose Revision Surgery)

•  Lateral strut grafts
•  Flip Flop grafts
• Alar batten grafts
• Alar rim grafts
• Lateral Crus Pull-up 
• Lateral Crural J-Flap

http://drtroell.com/papers/Nasal_Alar_Rim_Reconstruction.pdf
http://archfaci.ama-assn.org/content/8/5/333.full.pdf
http://oto.sagepub.com/content/128/5/640.full

Revision Osteotomy with outfracture of nasal bone

Narrowing the Columella for (ENVC)
http://spray.me.jhu.edu/~rothbaum/Articles_for_IDP/External%20valve.pdf

Injectable spreader grafts  *note

• hydroxyapatite (Radiesse)
• hyaluronic acid (Restylane)

http://findarticles.com/p/articles/mi_m0BUM/is_5_86/ai_n27270780/

*note

Dr. Dean Toriumi has reported serious issues with injectable fillers in the nose. Here is some information from his website on this issue.
The most concerning phenomenon is that many dermatologists, generalists and surgeons are performing non-surgical rhinoplasties. In these cases, semi-permanent or permanent injectable filler materials are being injected into the nose to make long lasting contour changes. Some of those who are performing the injections are not rhinoplasty surgeons and may have little if any understanding of the nasal anatomy and nasal aesthetics. I have seen many patients treated by such physicians with severe nasal skin envelope problems such as infection, swelling, pain, permanent redness and deformity. Unfortunately, many of these patients cannot be helped because correction of the problem requires resection of the filler material. Resection puts these patients at severe risk of permanent skin damage in the form of intense redness or skin necrosis, leaving a hole in their nose. Additionally, we do not know the long term effects of such materials on the nasal skin envelope.

There is an intense need for scientifically sound research that demonstrates the safety and efficacy of these materials in the nose. Scientific research may show that these filler materials when placed deeply against the bone and cartilage are safe when used in the nose. The nose is a very important structure of the face that greatly influences the overall facial appearance. Caution should be taken when doing anything that could potentially damage the nose and leave the patient with a permanent deformity.

Confused about what's the difference between Lateral crural strut grafts and alar strut grafts? Or rim grafts and Alar batten grafts?
Dr. Naderi explains in simple terms. Alar strut grafts and Lateral crural strut grafts are same.  But Alar batten grafts are not the same. A "rim graft" sits along the alar rim (right at the margin just like it sounds) whereas a "alar strut graft" site higher OVER the lateral aspect of the Lower Lateral Cartilage. The rim graft supports the soft tissue rim (nostril) while the strut graft supports the LLC laterally and thereby supports the entire nostril sidewall, not just the rim. An alar batten graft is a longer grafts that sits UNDER the lateral aspect of the Lower Lateral Cartilage and extends to the body pyriform apperture to prevent collapse of the nostrils during forceful inspiration.