• Internal nasal valve stabilization can be performed independently (as is seen in this video) or in combination with other nasal airway surgery, such as septoplasty and inferior turbinate reduction.
• Colorado tip cautery bent at 45 degrees is used to incise along the piriform rim
• This incision is made from the midpoint of the upper lateral cartilage at its caudal edge, following the curvature of the piriform rim to the superior border of the inferior turbinate
• A Cottle is used to elevate a plane between the upper lateral cartilage and the medial surface of the piriform rim
• The periosteum on the lateral piriform rim is incised
• A flap is elevated on the lateral surface of the piriform rim in a subperiosteal plane, exposing 10mm of bone from the caudal edge
• The stabilization of the upper lateral cartilage is planned
• A 1.2mm cross-cut fissure carbide burr is used to drill 2 holes in the piriform rim 2-3mm from the caudal edge and 5mm apart from each other
• It is important to ensure the drill is maintained perpendicular to the bony surface of the piriform rim
• A 3-0 Vicryl or PDS suture is passed lateral to medial through superior drill hole and the nasal mucosa
• The suture is passed back through the nasal mucosa in a vertical mattress fashion, with the more caudal second pass closer to the free edge of the mucosa, but maintaining enough free mucosa at the caudal edge that it will not easily pull through when tension is applied
• Both ends of the suture are clamped with a snap and placed aside
• A second suture is passed through the inferior hole in a similar fashion
• Tension is applied to the sutures to determine the final position of the internal nasal valve
• After the sutures are tied around the free edge of the piriform rim, the upper lateral cartilage rests in its final position – opening and stabilizing the internal nasal valve
• The mucosal edges are closed with 2 interrupted 4-0 plain gut sutures
• When internal nasal valve stabilization is performed in combination with inferior turbinate reduction, the incision for the inferior turbinate is extended to encompass the nasal valve stabilization incision
Thanks for the video. Does this stabilization hold up over time, though? Seems like all it does is pull the mucosa. I would think the problem would recur if you don’t address the cartilage, no?
Hi Egil,
The goal is to capture the inferior lateral portion of the upper lateral cartilage at least with the most superior suture. This, we believe, helps to create more robust long term results.