The nasal valve: New Methods for Reconstruction, Suspension and Objective measurements

This thesis is composed of 3 chapters. The first chapter deals with cartilaginous implants for the reconstruction of the nasal valve region and the nasal skeleton. In the first part of this chapter long-term results of homologous irradiated costal cartilage grafts in rhinoplasty are discussed for nine specific recipient sites in the nose. The second part describes a new surgical technique for the reconstruction of the nasal skeleton in Leprosy patients. The third part is a prospective study of children with partial or complete destruction of the cartilaginous nasal septum that were reconstructed with a new surgical technique with the use of autogenous cartilage from the auricle or rib affixed to PDS-plate. The second chapter deals with suspension suture techniques for widening the nasal valves and objective measurements in the evaluation of nasal patency. The first part of this chapter describes a new surgical technique for collapse of the external nasal valve, the "lateral crus pull-up". This technique uses a submucosal suspension suture between the distal part of the lateral crus of the lower lateral cartilage and the frontal process of the maxillary bone. The second part is a review report on suspension sutures in nasal valve surgery. The third part a new objective method to measure the minimal cross-sectional area of the nasal valve on CT (CT-MCA). In the fourth part CT-MCA is studied and compared with traditional methods to evaluate the patency of the nasal valve by comparing pre- and postoperative results in patients that underwent a lateral crus pull-up procedure. The last part of the chapter is an evidence based case report. In this report the question is raised whether functional septorhinoplasty provides improvement of the nasal passage in validated patient reported outcome measures (PROMs) for adults with an anatomical obstruction of the nasal valve. The last chapter deals with postoperative care of the nasal valve. A new custom made vestibular device was studied with the intention to decrease the risk of re-stenosis.