Costal cartilage lateral crural strut graft vs cephalic crural turn-in for correction of external valve dysfunction

Henry P. Barham*, Anna Knisely, Jenna Christensen, Raymond Sacks, George N. Marcells, Richard J. Harvey

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    22 Citations (Scopus)


    IMPORTANCE: External nasal valve dysfunction (EVD) is a common cause of nasal obstruction.

    OBJECTIVE: To evaluate costal cartilage lateral crural strut grafts vs cephalic crural turn-in to support the weak lateral crus in patients with EVD.

    DESIGN, SETTING, AND PARTICIPANTS: In this prospective cohort study, patients with clinically diagnosed EVD were assessed at the Tertiary Rhinologic Center and underwent a costal cartilage underlay graft to the lateral crus or a cephalic turn-in cruralplasty.

    MAIN OUTCOMES AND MEASURES: Assessment of patient benefit was based on 22-Item Sinonasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation Scale (NOSE) scores. A Likert scale was also used to assess overall function and cosmesis. Objective assessment included postdecongestion nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area.

    RESULTS: Forty-one patients (mean [SD] 35.38 [12.73] years of age; 25 [61%] female) were assessed. Cephalic turn-in maneuver was used for 25 (61%) patients; costal cartilage lateral crural strut grafts, 16 (39%) patients. Costal cartilage grafts were used in patients undergoing revision but other baseline data were similar. Follow-up was mean 10.58 (7.52) months. All patients had significantly improved visual analog scale, SNOT-22, NOSE, patient-reported function, and cosmesis scores. The only objective test that improved was nasal peak inspiratory flow (114.76 [60.48] L/min vs 126.46 [61.17] L/min; P = .02).

    CONCLUSIONS AND RELEVANCE: Both techniques were effective in improving patient-reported outcomes and nasal peak inspiratory flow. Both are functionally and cosmetically viable options for correction of EVD.


    Original languageEnglish
    Pages (from-to)340-345
    Number of pages6
    JournalJAMA Facial Plastic Surgery
    Issue number5
    Publication statusPublished - 1 Sep 2015


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