The effects of lateral crural tensioning with an articulated alar rim graft versus lateral crural strut graft on nasal function

Importance: Nasal valve dysfunction can be addressed by various valve reinforcement techniques. There is no consensus on which technique is most efficacious.

Objective: To evaluate lateral crural tensioning with articulated alar rim grafting (LCT/AARG) versus the lateral crural strut graft (LCSG) for their efficacy as nasal valve reinforcement techniques in rhinoplasty.

Design, Setting, and Participants: A cohort study was undertaken on patients who underwent either the LCT/AARG or LCSG as part of their rhinoplasty procedure. Airway testing was performed preoperatively and 6 months after the procedure, with data collected from February 2015 to July 2018 at a single tertiary rhinologic practice. Consecutive adults underwent open structure septorhinoplasty by one surgeon for both cosmetic and functional indications, as both primary and revision cases.

Main Outcomes and Measures: The primary functional outcomes analyzed were the nasal peak inspiratory flow (NPIF) and total nasal airway resistance (NAR). The primary patient-reported outcome measures analyzed were the visual analogue scale (VAS) for nasal obstruction, the Nasal Obstruction Symptom Evaluation (NOSE), and nasal obstruction score. Data were also normalized as a percentage improvement over preoperative baseline, to account for individual variability.

Results: In total 94 participants were recruited (33.7 ± 11.7 years, 85.3% female) with 26.6% in the LCT/AARG group and 73.4% in the LCSG group. Change in NAR (ΔNAR) was significantly better in the AARG group (-18.73 +/- 26.84 Pa/cc(3) vs. 15.07 ± 55.57 Pa/cc³, p <0.001). In addition, NAR improved significantly when analysis was isolated to the LCT/AARG group (0.414 ± 0.255 Pa/(cc³•s) vs. 0.291 ± 0.116 Pa/(cc³•s), Δ= -0.122 Pa/(cc³•s), p = 0.004) despite change in NAR being insignificant for the entire study population after surgery (0.370 ± 0.177 Pa/(cc³•s) vs. 0.349 ± 0.152 Pa/(cc³•s), Δ= 0.021, p = 0.320). There were no significant differences between the study groups in ΔNPIF (15.85 ± 31.48 L/min vs. 8.20 ± 30.12 L/min, p = 0.285), ΔVAS (35.77 ± 130.52 vs. 31.38 ± 73.19, p = 0.838), ΔNOSE (-73.60 ± 25.43 vs. -27.31 ± 123.44, p = 0.085), and Δnasal obstruction (64% experiencing improvement vs. 63.2% experiencing improvement, p = 0.097).

Conclusions and Relevance: LCT/AARG demonstrated benefit in total NAR over the LCSG. There were no other significant functional differences between the two techniques.