how is nasal valve reconstruction

 

¿how is nasal valve reconstruction?

Nasal valve reconstruction is a medical procedure used to restore normal functioning of the nasal passageways, often caused by a deviated septum or structural irregularities in the nose. The purpose of nasal valve reconstruction is to reduce airway obstruction, which can affect breathing and cause snoring and apnea. In the United States, nasal valve reconstruction can be performed in a variety of ways, with open and closed techniques and endoscopic and laser approaches. 

Nasal valve obstruction (NVO) is a common cause of nasal airway obstruction, which can lead to chronic nasal congestion, sleep disturbance, and decreased quality of life. The nasal valve is the narrowest part of the nasal airway, located in the region of the internal nasal valve, which is formed by the caudal edge of the upper lateral cartilages, the septum, and the nasal floor. Nasal valve reconstruction (NVR) is a surgical technique used to address NVO, which involves modifying the nasal valve area to improve nasal airflow. In this article, we will discuss the different techniques and approaches to NVR in the United States.

First, it is important to understand the anatomy of the nasal valve in order to better understand how nasal valve reconstruction works. The nasal valve is a narrow portion of the nasal passageway located between the nasal bone and the soft tissue of the face. This is the location in which nose breathing abnormalities frequently occur. The valve is made up of two portions: an internal, primary valve and an external, secondary valve. The primary valve is mainly located between the septum and the lower turbinate, while the secondary valve is primarily located between the upper turbinate and the bones of the face. The entire unit is called the “valve complex,” and its primary purpose is to provide directional control of airflow and maintain a negative pressure in the nose.

When the nasal valve is narrowed, it can create difficulty breathing through the nose. Symptoms of nasal valve collapse (NVC) may include snoring, sleep apnea, nasal congestion, and breathing distress. These issues can be caused by a variety of factors, including structural problems, trauma, and allergies, among others. In these cases, nasal valve reconstruction may be necessary to restore the normal functioning of the nose. 

When considering nasal valve reconstruction, there are a variety of methods available in the United States, including open and closed techniques, endoscopic, and laser approaches. An open technique involves making an incision beneath the upper lip to

access the nasal valve complex for repairs. During this surgical approach, the valve complex is carefully inspected and necessary corrections are made. The endoscopic technique is done with small specialized instruments, allowing for less invasive and more accurate repairs. Endoscopic procedures usually involve the use of soft tissue grafts to add structural support to the valve. Lastly, laser treatments may be used in some cases of NVC to reduce the size of the valve opening and create smoother surfaces in order to improve airflow. Laser treatments have the advantage of being relatively quick and painless compared to open and endoscopic techniques.

Regardless of technique, the goal of all nasal valve reconstruction surgeries is to reduce airway obstruction and improve overall nasal function. In most cases, the surgery will correct the underlying deformities causing the airway obstructions, resulting in improved breathing and a reduction in snoring and/or sleep apnea. In severe cases, more involved procedures may be necessary. Following surgery, the patient may need to use nasal steroids or decongestants to improve the progress of their recovery. Occasionally, follow-up procedures may be needed to address scar tissue or to open areas where there is additional obstruction.

Overall, nasal valve reconstruction is a safe, effective way to restore functioning of the nasal passageways. The American Board of Plastic Surgery highly recommends nasal valve reconstruction for patients who have diagnosed structures that cause airway obstruction due to its potential to improve quality of life in many areas. Patients should discuss the potential risks and benefits of the procedure with their doctor in order to determine the best course of treatment.

Prevalence and Symptoms of Nasal Valve Obstruction

NVO is a common condition, affecting up to 40% of patients who seek medical attention for nasal airway obstruction. The prevalence of NVO increases with age, and it is more common in women than men. NVO can result from a variety of causes, including congenital abnormalities, traumatic injury, and nasal surgery. It can also occur as a result of aging, as the nasal structures lose their rigidity and become weaker over time.

The symptoms of NVO include nasal congestion, difficulty breathing through the nose, snoring, and sleep disturbance. Patients with NVO may also experience chronic nasal drainage, sinus infections, and headache. NVO can have a significant impact on a patient's quality of life, leading to decreased energy levels, daytime fatigue, and cognitive impairment.

Diagnostic Evaluation

The evaluation of patients with NVO begins with a detailed medical history and physical examination. The nasal airway is evaluated using nasal endoscopy, which allows for visualization of the internal nasal valve. Additional diagnostic tests, such as acoustic rhinometry and rhinomanometry, can be used to quantify the degree of nasal obstruction and help guide treatment planning.

Nasal Valve Reconstruction Techniques

There are several surgical techniques used to reconstruct the nasal valve, including both open and endoscopic approaches. The choice of technique depends on the specific anatomy of the patient's nasal valve and the severity of the obstruction.

Caudal Septal Extension Graft (CSEG)

The caudal septum extension graft (CSEG) technique is a commonly used approach for NVR. This technique involves using a graft from the patient's septum or ear cartilage to extend the caudal edge of the septum, which in turn supports the lateral nasal wall and increases the size of the internal nasal valve. The CSEG technique can be performed through an open or endoscopic approach.

Open Approach

In the open approach, a small incision is made in the columella, the tissue that separates the nostrils, to gain access to the nasal structures. The septal cartilage is then harvested and fashioned into a graft, which is placed along the caudal edge of the septum to provide additional support to the nasal valve.

Endoscopic Approach

In the endoscopic approach, the graft is placed using a minimally invasive technique through the nostrils. A small incision is made in the nasal lining, and the graft is positioned in place using a specialized instrument.

Spreader Grafts

Spreader grafts are another commonly used technique for NVR. This technique involves placing a graft between the upper lateral cartilages of the nose, which helps to increase the width of the internal nasal valve. Spreader grafts can be made from the patient's septum or ear cartilage.

Open Approach

In the open approach, a small incision is made in the columella to gain access to the nasal structures. The graft is then harvested and placed between the upper lateral cartilages to support the nasal valve.