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. 2018 Mar 1;20(2):111-115.
doi: 10.1001/jamafacial.2017.0718.

Repair of Lateral Wall Insufficiency

Reza Vaezeafshar  1 , Sami P Moubayed  1 , Sam P Most  1
Affiliations

Repair of Lateral Wall Insufficiency

Reza Vaezeafshar et al. JAMA Facial Plast Surg. .

Abstract

Importance: Lateral wall insufficiency (LWI) is classified by the zone in which it occurs. Multiple techniques for treating LWI are described in the literature and are used, but no treatment approach has been widely adopted.

Objective: To establish an algorithm for treatment of LWI by evaluating subjective and objective outcomes of patients who underwent LWI repair and comparing these results with those of a control group who received no specific LWI repair.

Design, setting, and participants: This case-control study was conducted in a tertiary referral center. In group 1, there were 44 patients who underwent septorhinoplasty to repair LWI between February 1, 2014, and May 31, 2016. In group 2, there were 44 age- and sex-matched patients who underwent cosmetic septorhinoplasty without LWI repair. Data analysis was conducted from February 1, 2014, to May 31, 2016.

Intervention: Open septorhinoplasty.

Main outcomes and measures: Nasal Obstruction Symptom Evaluation (NOSE) scores and LWI grades.

Results: Forty-four patients (8 men and 36 women, with a mean [SD] age of 46 [16] years) who underwent open septorhinoplasty to repair LWI and 44 age- and sex-matched patients (composed of 8 men and 36 women, with a mean [SD] age of 41 [12] years) were included in the study. The mean (SD) preoperative NOSE scores were 69.4 (22) in group 1 and 20.5 (20.8) in group 2 (P < .001). The NOSE scores in both groups significantly improved after surgery (44.7 [95% CI, -28.9 to -49.9; P < .001] and -14.5 [95% CI, -2.7 to -18.5; P = .02]), although the improvement in group 2 was not clinically significant. The mean preoperative LWI grades were higher in group 1 than in group 2 for each zone (P < .001 and P = .001) but were similar between groups for each zone after surgery. Postoperative LWI scores significantly decreased in group 1 to levels similar to that of group 2. A positive linear correlation was noted between NOSE scores and LWI grades, with the strongest correlation between preoperative zone 1 LWI grades and NOSE scores (R = 0.68). Lateral crural strut grafts were used for zone 1 LWI and alar rim grafts were used for zone 2 LWI.

Conclusions and relevance: The LWI grading system enables surgeons to localize LWI, tailor the surgical treatment to the patient, and monitor improvements in the postoperative period.

Level of evidence: 3.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Zones of Lateral Nasal Wall Insufficiency
Zone 1 (upper zone) corresponds to dynamic internal nasal valve collapse. Zone 2 (lower zone) corresponds to classic external valve collapse. Reprinted with permission from OceanSide Publications.
Figure 2.
Figure 2.. Comparison of Lateral Wall Insufficiency (LWI) Grades Between Groups Over Time (t Test)
Figure 3.
Figure 3.. Comparison of Nasal Obstruction Symptom Evaluation (NOSE) Scores Between Groups Over Time (t Test)
The NOSE score has a range from 0 to 100, with 100 indicating the worst nasal obstruction symptoms.
See this image and copyright information in PMC

References

    1. Most SP. Trends in functional rhinoplasty. Arch Facial Plast Surg. 2008;10(6):410-413. - PubMed
    1. Tsao GJ, Fijalkowski N, Most SP. Validation of a grading system for lateral nasal wall insufficiency. Allergy Rhinol (Providence). 2013;4(2):e66-e68. - PMC - PubMed
    1. Most SP. Comparing methods for repair of the external valve: one more step toward a unified view of lateral wall insufficiency. JAMA Facial Plast Surg. 2015;17(5):345-346. - PubMed
    1. 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(2):157-163. - PubMed
    1. Lipan MJ, Most SP. Development of a severity classification system for subjective nasal obstruction. JAMA Facial Plast Surg. 2013;15(5):358-361. - PubMed