Internal Nasal Valve Stabilization

Video Type: CVideo
  • 2-5 min videos of a particular surgery or technique. These again show major events in the surgery
  • Clearly annotated and narration is a must in these videos
  • These have clear but concise abstracts are not able to be indexed in PubMed
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  • Peer reviewed

Author: Graeme Mulholland
Published:
Specialties: Otolaryngology, Rhinology Skullbased, Sleep Apnea
Schools: Emory University
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Basic Info

Dynamic internal nasal valve collapse is common form of nasal valve collapse that can be difficult to address surgically. There have been many surgical techniques described to stabilize and improve the function of the internal nasal valve. Our presented technique is a simple and reproducible surgical technique that has proved reliable in treatment of dynamic internal nasal valve collapse. This video clearly describes and demonstrates our internal nasal valve stabilization technique.

Advanced

Procedure

• 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

Indications

Dynamic internal nasal valve collapse, nasal obstruction.

Contraindications

Relative: non-dynamic internal nasal valve collapse.

Instrumentation

Setup

Standard setup for nasal surgery (septoplasty). With addition of needle point cautery and 1.2mm cross-cut fissure carbide burr with drill.

Preoperative Workup

Routine for nasal surgery. Can better select for patients with dynamic internal nasal valve collapse by in office physical exam maneuver utilizing the modified Cottle maneuver.

Anatomy and Landmarks

Caudal border of upper lateral cartilage, nasal septum, inferior turbinate and nasal piriform rim.

Advantages/Disadvantages

Most appropriate for dynamic internal nasal valve collapse. Less beneficially in cases of fixed internal nasal valve collapse (the internal nasal valve angle is collapsed, less than 10 degrees).

Complications/Risks

Bleeding, infection, bruising along infraorbital rim, failure to improve nasal breathing and failure to sufficiently stabilize the internal nasal valve.

Disclosure of Conflicts

We have no conflicts to disclose.

Acknowledgements

References

Weaver, EM. Nasal valve stabilization. Op Tech in Oto. 2012; 23: 67-71.

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