Surgical reconstruction of constricted nasal luminal valves have resulted in patients having good results with significant improvement to nasal breathing. The following research conducted by Dr. Wolford discusses how surgery can relieve the constricture of the nasal luminal valves that can result in increases in nasal resistance and decreases air flow.
Surgical Reconstruction of the Nasal Luminal Valves
By Larry M. Wolford DMD; Eber L.L. Stevao DDS, PhD
Statement of the problem:
Nasal airway obstruction is commonly associated with dentofacial deformities. An often over-looked area of potential obstruction involves the nasal luminal valves. Constricture of the luminal valves increases nasal resistance and decreases air flow.
The nasal luminal valve is the intranasal elevated ring of tissue at the junction of the skin and nasal mucosa, located 5 to 8 mm posterior to the nostril sil. Some patients may have severe constricture of the luminal valves causing partial nasal airway obstruction. This obstruction can be identified by direct visual inspection. The use of a nasal speculum to open the luminal valve by expansion should significantly improve the nasal air flow, providing there are no severe obstructions posterior to the valves (i.e. hyperplastic turbinates, septal deviation or spurs, polyps, etc). When the luminal valves are causing airway obstruction, reconstruction may be indicated. A new technique for reconstruction of the nasal valves will be presented.
Under local or general anesthesia, the majority of the elevated portion of the luminal valve tissue band is excised. An A-P incision is made at the infero-lateral aspect of the nasal floor to allow tension free reclosure of the tissues along the superior and lateral aspect of the nose. The incision is closed leaving a tissue defect at the floor and lower lateral aspect of the nose. We have incorporated 2 types of tissue grafts to cover the defect: 1) Split thickness palatal dermal graft, and 2) Alloderm (preferred). Tacking sutures are placed to stabilize the graft. A nasal stent is constructed from a soft, pliable nasopharyngeal tube (sizes 26 to 32) 8 to 12 mm in length. The stent is cut through and sutured with nylon to make a tear-drop shape. The stent is then inserted and maintained in place for 6 to 8 weeks, with removal only for cleaning.
Summary of personal experience
We have used this technique on 8 patients with the only complication associated with premature removal of the stent (at 2 weeks) in the first patient, resulting in some subsequent reformation of an elevated scar band recreating some obstruction. The other patients have had very good results with significant improvement to nasal breathing.
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- Shaida AM, Kenyon GS. The nasal valves: changes in anatomy and physiology in normal subjects. Rhinology Mar 38(1);7-12, 2000.