NJ Plastic Surgery

PATIENTS, MATERIALS, AND METHODS

All patients in this study presented with a history of rhinoplasty, which had occurred at least 2 years ago. All patients had been taking some form of medication to relieve obstructed nasal breathing; these included nasal sprays, both decongestant and corticosteroid; oral antihistamines; and decongestants. The following criteria were used for offering patients a nasal valve suspension procedure:

• Obstructed breathing, unilateral or bilateral, asso­ciated with medial displacement of the nasal valve com­plex.
• A nasal valve complex that exhibited significant in-ward displacement with inspiration.
• A lack of response to the use of oral and topical medication to reduce turbinate hypertrophy associated with the 2 previous criteria.
• A positive Cottle maneuver, ie, an instantly im­proved nasal airway with superolateral retraction of the na­solabial folds.'
• A 2-week trial of the external nasal dilator to con-firm that lateralization of the ULC relieved symptoms.

The patients were asked to subjectively rate the post-operative nasal airway as worse, unchanged, or improved.

If the postoperative nasal airway was improved, patients were asked to judge whether the improvement was satisfactory. Preoperative and postoperative photographs were taken for analysis.

	Figure 1. The nasal valve was suspended from the infraorbital periosteum.

The surgical technique involved outlining a 1- to L5-cm incision line at the junction of the subunits of lower lid skin and the cheeks. This subunit junction provided the best site for healing of the incision to prevent any visible scar. The incision was carried down to the area of the periosteum, just below the infraorbital rim (Figure 1).

Care was taken to leave not only the periosteum but also a little soft tissue, because the periosteum is thin in this area and a strong holding area for the polypropylene suture was necessary. A 4-0 polypropylene suture on a P3 needle was passed through the periosteum and soft tissue and retained as an anchor point. A 4-0 polypropylene suture using 2 Keith needles was then passed superiorly and laterally to the inwardly rotated nasal valve, exiting through the infraorbital incision. At this point, the 2 ends of the polypropylene suture were tied to the previously placed infraorbital retaining suture. Such suspension of the lateral nasal valve wall was performed at the junction of the superior portion and midthird of the nasal valve. The second suture was placed at the junction of the midthird and lower third of the nasal valve. We then have 2 points at the junction of the ULC and lower lateral cartilage on the nasal valve retracted in a superolateral direction. To achieve symmetry, this procedure was done on both sides, even if the nasal valve stenosis was unilateral. Initially, the sutures were exposed intranasally. However, on follow-up examinations, they were buried submucosally.

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