Facial Plast Surg 2023; 39(06): 616-620
DOI: 10.1055/s-0043-1773767
Original Article

Management of Lateral Wall Insufficiency

1   Head and Neck Institute, Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Cleveland, Ohio
,
Sofia Lyford-Pike
2   Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota
› Author Affiliations

Abstract

Lateral wall insufficiency is a commonly encountered etiology of nasal obstruction, resulting from dynamic collapse at the level of the internal or external nasal valve. Various management strategies exist to strengthen the lateral wall or stent the nasal valves to relieve nasal obstruction, and range from noninvasive devices, minimally invasive implants, or surgical reconstructive techniques. Surgical options to address the nasal valves are selected based on each patient's anatomic findings, aesthetic and functional goals, and surgeon preference. This article describes the anatomy and physiology of the nasal sidewall and nasal valves and diagnosis of lateral wall insufficiency, and provides a framework for treatment options.



Publication History

Article published online:
14 September 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Hamilton III GS. The external nasal valve. Facial Plast Surg Clin North Am 2017; 25 (02) 179-194
  • 2 Rhee JS, Weaver EM, Park SS. et al. Clinical consensus statement: diagnosis and management of nasal valve compromise. Otolaryngol Head Neck Surg 2010; 143 (01) 48-59
  • 3 Bridger GP. Physiology of the nasal valve. Arch Otolaryngol 1970; 92 (06) 543-553
  • 4 Howard BK, Rohrich RJ. Understanding the nasal airway: principles and practice. Plast Reconstr Surg 2002; 109 (03) 1128-1146 , quiz 1145–1146
  • 5 Kasperbauer JL, Kern EB. Nasal valve physiology. Implications in nasal surgery. Otolaryngol Clin North Am 1987; 20 (04) 699-719
  • 6 Tsao GJ, Fijalkowski N, Most SP. Validation of a grading system for lateral nasal wall insufficiency. Allergy Rhinol (Providence) 2013; 4 (02) e66-e68
  • 7 Vaezeafshar R, Moubayed SP, Most SP. Repair of lateral wall insufficiency. JAMA Facial Plast Surg 2018; 20 (02) 111-115
  • 8 Das A, Spiegel JH. Evaluation of validity and specificity of the Cottle maneuver in diagnosis of nasal valve collapse. Plast Reconstr Surg 2020; 146 (02) 277-280
  • 9 Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg 2004; 130 (02) 157-163
  • 10 Moubayed SP, Ioannidis JPA, Saltychev M, Most SP. The 10-item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) for functional and cosmetic rhinoplasty. JAMA Facial Plast Surg 2018; 20 (01) 37-42
  • 11 Kiyohara N, Badger C, Tjoa T, Wong B. A comparison of over-the-counter mechanical nasal dilators: a systematic review. JAMA Facial Plast Surg 2016; 18 (05) 385-389
  • 12 Wong LS, Johnson AT. Decrease of resistance to air flow with nasal strips as measured with the airflow perturbation device. Biomed Eng Online 2004; 3 (01) 38
  • 13 Raudenbush B. Stenting the nasal airway for maximizing inspiratory airflow: internal Max-Air Nose Cones versus external Breathe Right strip. Am J Rhinol Allergy 2011; 25 (04) 249-251
  • 14 Peltonen LI, Vento SI, Simola M, Malmberg H. Effects of the nasal strip and dilator on nasal breathing–a study with healthy subjects. Rhinology 2004; 42 (03) 122-125
  • 15 White Jr JR, Hamilton III GS. Mitek suspension of the lateral nasal wall. Facial Plast Surg 2016; 32 (01) 70-75
  • 16 Page MS, Menger DJ. Suspension suture techniques in nasal valve surgery. Facial Plast Surg 2011; 27 (05) 437-441
  • 17 Nuara MJ, Mobley SR. Nasal valve suspension revisited. Laryngoscope 2007; 117 (12) 2100-2106
  • 18 àWengen DF. Titanium implants in the nose: state of the art. Facial Plast Surg 2022; 38 (05) 461-467
  • 19 Goldman ND, Alexander R, Sandoval LF, Feldman SR. Nasal valve reconstruction using a titanium implant: an outcomes study. Craniomaxillofac Trauma Reconstr 2017; 10 (03) 175-182
  • 20 Hurbis CG. An adjustable implant for nasal valve dysfunction: a 3-year experience. Ear Nose Throat J 2012; 91 (08) E5-E12
  • 21 Gürlek A, Celik M, Fariz A, Ersöz-Oztürk A, Eren AT, Tenekeci G. The use of high-density porous polyethylene as a custom-made nasal spreader graft. Aesthetic Plast Surg 2006; 30 (01) 34-41
  • 22 Sanan A, Most SP. A bioabsorbable lateral nasal wall stent for dynamic nasal valve collapse: a review. Facial Plast Surg Clin North Am 2019; 27 (03) 367-371
  • 23 Sidle DM, Stolovitzky P, Ow RA. et al. Twelve-month outcomes of a bioabsorbable implant for in-office treatment of dynamic nasal valve collapse. Laryngoscope 2020; 130 (05) 1132-1137
  • 24 Wilkins SG, Sheth AH, Kayastha D. et al. Adverse events associated with bioabsorbable nasal implants: a MAUDE database analysis. Otolaryngol Head Neck Surg 2023; 168 (05) 1253-1257
  • 25 Stolovitzky P, Senior B, Ow RA, Mehendale N, Bikhazi N, Sidle DM. Assessment of bioabsorbable implant treatment for nasal valve collapse compared to a sham group: a randomized control trial. Int Forum Allergy Rhinol 2019; 9 (08) 850-856
  • 26 Olson MD, Barrera JE. A comparison of an absorbable nasal implant versus functional rhinoplasty for nasal obstruction. Am J Otolaryngol 2021; 42 (06) 103118
  • 27 Kim DH, Lee HH, Kim SH, Hwang SH. Effectiveness of using a bioabsorbable implant (Latera) to treat nasal valve collapse in patients with nasal obstruction: systemic review and meta-analysis. Int Forum Allergy Rhinol 2020; 10 (06) 719-725
  • 28 Clark CM, Hakimi AA, Parsa KM. et al. Comparison of nasal obstruction symptom evaluation score outcomes after autologous cartilage grafts and Latera nasal implants. Ann Otol Rhinol Laryngol 2023; 132 (08) 912-916
  • 29 Ji KSY, Krane NA. Surgical treatment of dynamic nasal collapse. Facial Plast Surg 2022; 38 (04) 339-346
  • 30 Chua DY, Park SS. Alar batten grafts. JAMA Facial Plast Surg 2014; 16 (05) 377-378
  • 31 Toriumi DM, Josen J, Weinberger M, Tardy Jr ME. Use of alar batten grafts for correction of nasal valve collapse. Arch Otolaryngol Head Neck Surg 1997; 123 (08) 802-808
  • 32 Toriumi DM, Asher SA. Lateral crural repositioning for treatment of cephalic malposition. Facial Plast Surg Clin North Am 2015; 23 (01) 55-71
  • 33 Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 1997; 99 (04) 943-952 , discussion 953–955
  • 34 Silva Filho RdeO, Pochat VD. Anatomical study of the lateral crural strut graft in rhinoplasty and its clinical application. Aesthet Surg J 2016; 36 (08) 877-883
  • 35 Apaydin F. Lateral crural turn-in flap in functional rhinoplasty. Arch Facial Plast Surg 2012; 14 (02) 93-96
  • 36 Abdelwahab M, Patel P, Kandathil CK, Wadhwa H, Most SP. Effect of lateral crural procedures on nasal wall stability and tip aesthetics in rhinoplasty. Laryngoscope 2021; 131 (06) E1830-E1837
  • 37 Guyuron B, Bigdeli Y, Sajjadian A. Dynamics of the alar rim graft. Plast Reconstr Surg 2015; 135 (04) 981-986
  • 38 Boahene KDO, Hilger PA. Alar rim grafting in rhinoplasty: indications, technique, and outcomes. Arch Facial Plast Surg 2009; 11 (05) 285-289
  • 39 Ballin AC, Kim H, Chance E, Davis RE. The articulated alar rim graft: reengineering the conventional alar rim graft for improved contour and support. Facial Plast Surg 2016; 32 (04) 384-397