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Disorders of the nasal valve area.

Bloching MB - GMS Curr Top Otorhinolaryngol Head Neck Surg (2008)

Bottom Line: Within the framework of aetiology, static and dynamic disorders of the nasal valve area have to be distinguished since they result in different therapeutic measures.In this context, we distinguish between stabilisation techniques through grafts or implants and stabilising suture techniques.Following a thorough analysis, the correction of static nasal valve disorders requires various plastic-reconstructive measures using transposition grafting and skin or composite grafts.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otorhinolaryngology of the Saarland University, Homburg/Saar, Germany.

ABSTRACT
The nasal valve area is not a singular structure, but a complex three-dimensional construct consisting of several morphological structures. From the physiologic point of view, it is the place of maximum nasal flow resistance ("flow limiting segment"). Therefore, according to Poiseuille's law, even minor constrictions of this area result in a clinically relevant impairment of nasal breathing for the patient. This narrow passage, also called "ostium internum nasi", is formed by the mobile lateral nasal wall, the anterior septum with the swell body, the head of the inferior turbinate and the osseous piriform aperture. Within the framework of aetiology, static and dynamic disorders of the nasal valve area have to be distinguished since they result in different therapeutic measures. In the context of diagnosis, the exploration of the case history for assessing the patient's extent of suffering and the clinical examination are very important. In addition to the presentation of the basics of disorders of the nasal valves, this paper focuses on the treatment of dynamic disorders that mainly constitute the more important therapeutic issue. In this context, we distinguish between stabilisation techniques through grafts or implants and stabilising suture techniques. Following a thorough analysis, the correction of static nasal valve disorders requires various plastic-reconstructive measures using transposition grafting and skin or composite grafts.

No MeSH data available.


Related in: MedlinePlus

“Spreader grafts” were described for the first time by Sheen in 1984 for avoiding a functionally effective reduction of the cross section of the nasal valve after reduction rhinoplasty [16]. To this effect, 1-2 mm broad pins of cartilage are inserted between the septum and the lateral cartilage in an intact mucosal pocket and fixed using mattress sutures.
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Figure 6: “Spreader grafts” were described for the first time by Sheen in 1984 for avoiding a functionally effective reduction of the cross section of the nasal valve after reduction rhinoplasty [16]. To this effect, 1-2 mm broad pins of cartilage are inserted between the septum and the lateral cartilage in an intact mucosal pocket and fixed using mattress sutures.

Mentions: “Spreader grafts” were described for the first time by Sheen in 1984 and are intended to avoid a functionally effective reduction of the cross section of the nasal valve after reduction rhinoplasty [16]. This problem can occur after resection of a cartilaginous-bony hump with paramedian and lateral osteotomies for closing the “open roof”. In this case, this medialisation of the lateral nasal wall causes a constriction of the internal nasal valve. For avoiding this medialisation, 1-2 mm broad pins of cartilage are inserted between the septum and the lateral cartilage into an intact mucosal pocket (Figure 6 (Fig. 6)). Septal cartilage is most suitable in this case. According to Orten (1999) and our own experience, however, this results in an insignificant enlargement of the cross section of the internal nasal valve only since the angle of the nasal valve is changed only negligibly [40]. “Spreader grafts”, however, can harmonise the nasal dorsum after hump resection [41]. In the individual case, “spreader grafts” can also be used on one side only in order to compensate for minor asymmetries in the cartilaginous area of the nasal dorsum in case of high septal deviations that are difficult to correct. The fixation of the grafts is carried out using slowly absorbable fine mattress sutures (e.g. 5-0 polydioxanone). Acrylate-based tissue glues should not be used on account of the risk of inflammation despite their possible convenience [42]. Besides autologous materials, preshaped “spreader grafts” made of porous polyethylene are used today [43], [44]. The advantage offered is the shorter duration of the surgery. There are, however, characteristic disadvantages of foreign matter that are avoided by using autologous cartilage.


Disorders of the nasal valve area.

Bloching MB - GMS Curr Top Otorhinolaryngol Head Neck Surg (2008)

“Spreader grafts” were described for the first time by Sheen in 1984 for avoiding a functionally effective reduction of the cross section of the nasal valve after reduction rhinoplasty [16]. To this effect, 1-2 mm broad pins of cartilage are inserted between the septum and the lateral cartilage in an intact mucosal pocket and fixed using mattress sutures.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3199841&req=5

Figure 6: “Spreader grafts” were described for the first time by Sheen in 1984 for avoiding a functionally effective reduction of the cross section of the nasal valve after reduction rhinoplasty [16]. To this effect, 1-2 mm broad pins of cartilage are inserted between the septum and the lateral cartilage in an intact mucosal pocket and fixed using mattress sutures.
Mentions: “Spreader grafts” were described for the first time by Sheen in 1984 and are intended to avoid a functionally effective reduction of the cross section of the nasal valve after reduction rhinoplasty [16]. This problem can occur after resection of a cartilaginous-bony hump with paramedian and lateral osteotomies for closing the “open roof”. In this case, this medialisation of the lateral nasal wall causes a constriction of the internal nasal valve. For avoiding this medialisation, 1-2 mm broad pins of cartilage are inserted between the septum and the lateral cartilage into an intact mucosal pocket (Figure 6 (Fig. 6)). Septal cartilage is most suitable in this case. According to Orten (1999) and our own experience, however, this results in an insignificant enlargement of the cross section of the internal nasal valve only since the angle of the nasal valve is changed only negligibly [40]. “Spreader grafts”, however, can harmonise the nasal dorsum after hump resection [41]. In the individual case, “spreader grafts” can also be used on one side only in order to compensate for minor asymmetries in the cartilaginous area of the nasal dorsum in case of high septal deviations that are difficult to correct. The fixation of the grafts is carried out using slowly absorbable fine mattress sutures (e.g. 5-0 polydioxanone). Acrylate-based tissue glues should not be used on account of the risk of inflammation despite their possible convenience [42]. Besides autologous materials, preshaped “spreader grafts” made of porous polyethylene are used today [43], [44]. The advantage offered is the shorter duration of the surgery. There are, however, characteristic disadvantages of foreign matter that are avoided by using autologous cartilage.

Bottom Line: Within the framework of aetiology, static and dynamic disorders of the nasal valve area have to be distinguished since they result in different therapeutic measures.In this context, we distinguish between stabilisation techniques through grafts or implants and stabilising suture techniques.Following a thorough analysis, the correction of static nasal valve disorders requires various plastic-reconstructive measures using transposition grafting and skin or composite grafts.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otorhinolaryngology of the Saarland University, Homburg/Saar, Germany.

ABSTRACT
The nasal valve area is not a singular structure, but a complex three-dimensional construct consisting of several morphological structures. From the physiologic point of view, it is the place of maximum nasal flow resistance ("flow limiting segment"). Therefore, according to Poiseuille's law, even minor constrictions of this area result in a clinically relevant impairment of nasal breathing for the patient. This narrow passage, also called "ostium internum nasi", is formed by the mobile lateral nasal wall, the anterior septum with the swell body, the head of the inferior turbinate and the osseous piriform aperture. Within the framework of aetiology, static and dynamic disorders of the nasal valve area have to be distinguished since they result in different therapeutic measures. In the context of diagnosis, the exploration of the case history for assessing the patient's extent of suffering and the clinical examination are very important. In addition to the presentation of the basics of disorders of the nasal valves, this paper focuses on the treatment of dynamic disorders that mainly constitute the more important therapeutic issue. In this context, we distinguish between stabilisation techniques through grafts or implants and stabilising suture techniques. Following a thorough analysis, the correction of static nasal valve disorders requires various plastic-reconstructive measures using transposition grafting and skin or composite grafts.

No MeSH data available.


Related in: MedlinePlus