Background and objective

The internal nasal valve (INV) is located in the middle third of the nose where the upper lateral cartilages join the nasal septum. Sometimes, the upper lateral cartilage collapses and causes ventilatory difficulty and aesthetic nonconformity. Our aim is to associate tomographic variables with sensation of aesthetic and ventilatory improvement, 3 months after using spreader-grafts.

Methods

Longitudinal study of patients with simultaneous nasal aesthetic non conformity and ventilation difficulty that undergo rhinoplasty with spreader-graft collocation, and description of some surgical examples.

Bone-based CT determines preoperative and 3 months postoperative angles of the INV; subjective aesthetic and/or ventilatory improvement is recorded clinically too. A comparative analysis was carried out, testing for the homogeneity of the sample data: Chi-squared test for pre and postoperative angles, as well as for spreader-graft diameter; binomial test for “V” deformity; Kolmogorov-Smirnov for age. In order to associate each independent variable with aesthetic and ventilatory improvement, RR (CI 95%), PPV and NPV were calculated.

Results

Sample with 61 patients. Spreader-graft diameter: >4mm (27.9%), RR ventilatory improvement 1.43 (IC al 95%, 1.12 -1.82); 2-4mm (44.3%); 2mm (27.9%). Preoperative valve angle: 15-10º (16.4%); 10-5º (50.8%); <5º (32.8%). Postoperative valve angle: 10º (44.3%); 10-15º (47.5%); >15º (8.2%). With (63.9%) or without (36.1%) inverted “V” nasal deformity. Aesthetic and ventilatory improvement (60.7%), isolated aesthetic improvement (11.5%), isolated ventilatory improvement (13.1%), no improvement at all (14.8%).

Conclusions

Spreader-graft >4 mm has a statistically significant association with ventilatory improvement, along with variable clinical significance; 15-10º preoperative valve angle is associated as well with aesthetic and ventilatory improvement.

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