Nasal Valve Tensioning versus Crural Strut Grafts in the Management of External Nasal Valve Dysfunction

BACKGROUND: External nasal valve dysfunction, a common cause of nasal obstruction, is unlikely to be restored with septoplasty or turbinoplasty alone. This study assessed 2 rhinoplasty techniques for the prevention and treatment of external nasal valve dysfunction: lateral crural tensioning with articulated alar rim grafts (LCT/AARG) and lateral crural strut grafts (LCSG) in primary and revision rhinoplasty. METHODS: A retrospective cohort analysis was performed. Patients received LCT/AARG or LCSG. Assessment occurred at baseline and at least 6 months after surgery. The primary outcome was nasal obstruction sensation, measured by a visual analog scale; the Nasal Obstruction Symptom Evaluation; and an ordinal nasal obstruction score. Secondary outcomes were nasal airflow (assessed by nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area) and patient-perceived aesthetic results (assessed by the Rhinoplasty Outcome Evaluation and a 13-point ordinal score). RESULTS: A total of 203 primary rhinoplasty and 108 revision rhinoplasty patients were included. Both techniques had positive effects in primary and revision cases. In primary rhinoplasty, LCT/AARG was more effective than LCSG in improving nasal obstruction (category improvement of 1 or greater in nasal obstruction score, 81% versus 64% [ P < 0.01]), nasal airflow (change in nasal peak inspiratory flow, 21.00 ± 46.43 L/min versus 4.32 ± 42.64 L/min [ P = 0.01] and change in nasal airway resistance on the obstructed side, -0.29 [-0.71 to 0.03] Pa/cm 3 /s versus -0.11 [-0.56 to 0.18] [ P = 0.03]), and Rhinoplasty Outcome Evaluation score (42 [21 to 54] versus 31 [13 to 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 with LCSG.