Semi-wrapping lateral cartilage to a square edged strut perpendicularly to prevent collapse in external nasal valve dysfunction: pseudodome technique

Abstract

Objectives: During inhalation through the nose, the weakness of lateral cartilage may cause the collapse of nasal vestibule and sidewall, causing the complaint of difficult breathing through the nose. We aimed to support the lateral cartilage with a square edged strut to resolve this problem.

Methods: We described a technique in 8 cases (5 males, 3 females). In this technique the lateral cartilage is semi wrapped from the underside to a square edged strut, and arched to outside with an open approach rhinoplasty. As it was only a physical support and did not create a new canting up through the skin, we named this maneuver as pseudodome technique.

Results: All patients experienced relief of symptoms and no complications observed. The reinforcement effect of the strut was effective in preventing collapse of the nasal alar sidewall as well as did not cause contour irregularities.

Conclusions: Pseudodome technique can be performed for acquired or congenital nasal sidewall collapse caused by lower lateral cartilage structural weaknesses successfully. 

Keywords

• nasal valve,lateral cartilage,pseudodome technique,open approach rhinoplasty

References

1. [1] Mink PJ. Le nezcommevoierespiratoire. Presse Otolaryngol Belg 1903;21:481-96.
2. [2] Chand MS and Toriumi DM: Nasal physiology and management of the nasal airway. In; Dallas Rhinoplasty-Nasal Surgery by the Masters, Gunter JP, Rohrich RJ, Adams WP Jr. eds., Quality Medical Publishing, Inc: St. Louis, Missouri, 2002, pp.643-61.
3. [3] O'Halloran LR. The lateral crural J-flap repair of nasal valve collapse. Otolaryngol Head Neck Surg 2003;128:640-9.
4. [4] Bloching MB. Disorders of the nasal valve area. GMS Curr Top Otorhinolaryngol Head Neck Surg 2007;6:Doc07.
5. [5] Roithmann R, Chapnik J, Zamel N, Barreto SM, Cole P. Acoustic rhinometric assessment of the nasal valve. Am J Rhinol 1997;11:379-85.
6. [6] Ricci E, Palonta F, Preti G, Vione N, Nazionale G, Albera R, et al. Role of nasal valve in the surgically corrected nasal respiratory obstruction: evaluation through rhinomanometry. Am J Rhinol 2001;15:307-10.
7. [7] Cakmak O, Coşkun M, Celik H, Büyüklü F, Ozlüoğlu LN. Value of acousticrhinometry for measuring nasal valve area. Laryngoscope 2003;113:295-302.
8. [8] Ozturan O, Miman MC, Kizilay A. Bending of the upper lateral cartilages for nasal valve collapse. Arch Facial Plast Surg 2002;4:258-61.

9. [9] Paniello RC. Nasal valve suspension. An effective treatment for nasal valve collapse. Arch Otolaryngol Head Neck Surg l996;122:1342-6.
10. [10] Schlosser RJ, Park SS. Functional nasal surgery. Otolaryngol Clin North Am 1999;32:37-51.
11. [11] Park SS. The flaring suture to augment the repair of the dysfunctional nasal valve. Plast Reconstr Surg 1998;101:1120-2.
12. [12] Stucker FJ, Lian T, Sanders K. Management of severe bilateral nasal wall collapse. Am J Rhinol 2002;16:243-8.
13. [13] Guyuron B, Michelow BJ, Englebardt C. Upper lateral splay graft. Plast Reconstr Surg 1998;102:2169-77.
14. [14] Teichgraeber JF, Wainwright DJ. The treatment of nasal valve obstruction. Plast Reconstr Surg 1994;93:1174-82.
15. [15] Farré R, Peslin R, Montserrat JM, Rotger M, Navajas D. Flow-dependent positive airway pressure to maintain airway patency in sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med 1998;157:1855-63.
16. [16] Beeson WH. The nasal septum. Otolaryngol Clin North Am 1987;20:743-67.
17. [17] Akduman D, Yanılmaz M, Haksever M, Doner F, Sayar Z. Patients` evaluation for the surgical management of nasal obstruction. Rhinology 2013;51:361-7.
18. [18] Toriumi DM, Becker DG. Injection. In; Rhinoplasty Dissection Manual, Lippincott-Williams&Wilkins, 1999:pp. 25-9.
19. [19] Romo T 3rd, Moutran HA, Pearson JM, Presti P, Yalamanchilli H. Postrhinoplasty Nasal Obstruction Rhinoplasty. Medscape. At available: http://emedicine.medscape.com/article/841574-overview#showall.
20. [20] Kern EB, Wang TD. Nasal valve surgery. In: Daniel RK, Regnault P, eds. Aesthetic Plastic Surgery - Rhinoplasty. 1st ed. Baltimore, MD: Lippincott Williams&Wilkins; 1993:pp. 613-30.
21. [21] Daniel K Rollin, Mastering Rhinoplasty. A Comprehensive Atlas of Surgical Techniques with Integrated Video Clips. Springer Science & Business Media, NY, 2010.
22. [22] Kridel RW, Konior RJ. Controlled nasal tip rotation via the lateral crural overlay technique. Arch Otolaryngol Head Neck Surg 1991;117:411-5.