"Nasal valve tensioning versus crural strut grafts in the management of external nasal valve dysfunction"

Background: External nasal valve dysfunction (EVD) is a common cause of nasal obstruction that is unlikely to be restored with septoplasty/turbinoplasty alone. This study aimed to assess two rhinoplasty techniques for the prevention and treatment EVD: lateral crural tensioning with articulated alar rim grafts (LCT) and lateral crural strut grafts (LCSG), in primary and revision rhinoplasty.

Methods: A retrospective cohort analysis was performed. Included patients received LCT or LCSG, defined by changing trends in practice over time. Assessment occurred at baseline and at least 6 months post-surgery. The primary outcome was sensation of nasal obstruction, measured by a visual analogue scale, the Nasal Obstruction Symptom Evaluation questionnaire, and an ordinal nasal obstruction score. Secondary outcomes were nasal airflow (assessed by nasal peak inspiratory flow (NPIF), nasal airway resistance (NAR), and minimum cross-sectional area (MCA)) and patient-perceived aesthetic (assessed by the Rhinoplasty Outcome Evaluation (ROE) questionnaire and a 13-point ordinal score).

Results: 203 primary (32[24-44] years, 75% female) and 108 revision (40[32-50] years, 78% female) rhinoplasty patients were included. Both techniques had positive effects in primary and revision cases. In primary rhinoplasty, LCT was more effective than LCSG in improving nasal obstruction (≥1 category improvement in nasal obstruction score: 81% vs. 64%; p<0.01), nasal airflow (ΔNPIF: 21.00±46.43L/min vs. 4.32±42.64L/min; p=0.01 and ΔNAR obstructed side: -0.29[-0.71-0.03]Pa/cm3/s vs. -0.11[-0.56-0.18]; p=0.03), and ROE (42[21-54] vs. 31[13-46]; p=0.02). Both techniques were similar in revision rhinoplasty.

Conclusion: LCT/AARG is a reliable technique offering improved airflow, reduced resistance, and better patient-reported outcomes compared to LCSG.