Eulogio Emílio Martinez Neto
ORLA clinic, Brazil
Posters & Accepted Abstracts: J Univer Surg
This is a case review of a primary nasal valve dysfunction corrected using an endonasal approach by a transfi xion incision. Due to the increasing understanding and manipulation of the nasal dorsum on aesthetic approaches, it is common to solve and predict valve disorders with the dorsum exposed and the lateral cartilages separated from the nasal septum. The aim is to consider this less aggressive endonasal approach in selected cases. Our patient had no aesthetic complaints or aesthetic changing desires and had an external valve collapse during nasal inspiration. After surgery we noticed the correction of the inspiration collapse, with little aesthetic changes and satisfaction of the patient. Key Words: Nasal valve, spreader graft, endonasal, rhinoplasty Introduction There are some situations in the nasal study, where the function and the aesthetics of the nose come together and it seems impossible to separate them in our surgical plan. Due to the comprehension and technical refi nement achieved by rhinology on the last decades, the use of grafts and visualization of nasal structures is done routinely with an acceptable prevision of results. Even then, the philosophy that sometimes less is best should always be at least remembered. Nasal valve dysfunction is commonly solved with lateral and dorsum grafts. The access of these areas is usually done with the dissection of the dorsum in open or closed approach and incisions of lateral cartilages for insertion and fi xation of the grafts. It is possible to solve some cases with no need of such dissection, using septal bilateral submucosal tunnels to position grafts that will prevent nasal collapse during inspiration. Objective To demonstrate a case of surgical treatment of nasal valve dysfunction using an endonasal approach technique. Preoperative Picture Showing Supra Alar Crease Dysfunction Submucosal Tunnel Dissection Preoperative Picture Showing Supra Alar Crease Dysfunction Preoperative Picture Showing Supra Alar Crease Dysfunction Methods A 29 years old male patient came to us at ORLA Clinic , Florianópolis,SC Brazil, with a complaint of nasal obstruction worse during forced inspiration during exercise activities. He had mild aesthetic dissatisfaction. During the medical appointment, with palpation and nasal fl ow dynamics evaluation, it was noticed and tested with handmade cotton cylinders approximately 2,5mm thick, placed bilaterally on the roof of the nose, that the lateral cartilage wouldn´t collapse with this inner angle extended. The surgical plan was to use a transfi xion incision and during septoplasty shape two equal cartilage rectangular grafts of approximate 2cm of length and 0.5cm of height. Perform a submucosal tunnel on the opposite side of the deviation (this side already dissected) and insert the grafts widening the roof and its angulations with the lateral cartilage. Once the grafts were in place, underneath the lower edge of the graft, a “U” suture from the vestibule, transfi xing the mucosa bilaterally parallel to the nasal fl oor was performed using an absorbable monocryl 4.0 thread to support the grafts and not allowing them to slide. The same thread was used to close the transfi xion incisions.Results One year after the surgical procedure, the patient is free of complaints and satisfi ed with the functional and aesthetic results. It is possible to palpate the grafts in the offi ce from above the mucosa and notice that they remain in place and thick. Placement of Graft Graft Fixation Support Suture One Year Post Operative Picture Conclusion The endonasal spreader graft technique can be very useful in nasal valve dysfunction. It does not require large dissections of the nose, is not aggressive and can be maintained in place with a septal suture done with absorbable thread. It can also be considered in rhinoplasties where the dorsal correction won´t require an opening of the nasal roof.
DR. EULÓGIO EMÍLIO MARTINEZ NETO Otorhinolaryngologist at ORLA Clinic in Florianópolis Brazil Fellow in Facial Plastic Surgery and Rhinology at Fellipu Institute by the Brazilian Society of Otorhinolaryngology Master's degree in Rhinology and Facial Plastic Surgery from the School of Medicine of Santa Casa de São Paulo Fellow in Endoscopic Face Sinus Surgery at Pittsburgh University, Pennsylvania Fellow in Endoscopic Paranasal Sinus Surgery and Skull Base Miami University Rhinoplasty Improvement Course in Portland, Oregon Member of the Brazilian Academy of Plastic Surgery and Face Reconstruction Member of the Brazilian Association of Otorhinolaryngology and Cervicofacial Surgery Brazilian Academy of Rhinology International Federation of Facial Plastic Surgery Society
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