비밸브 기능저하의 수술적 치료
Surgery for Nasal Valve Compromise
2
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
The nasal valve spans a minimal cross sectional area of the intake point inside the nose. Acting as a Starling’s resistor, it plays a pivotal role in controlling the inspiratory airflow. Nasal valve compromise, better known as nasal valve dysfunction, can be suspected when the patient complains of inspiratory nasal obstruction after trauma or surgery. If the patient has a history highly suspicious of nasal valve compromise, thorough physical examinations are mandatory in order to find the exact epicenter. The deformed L-strut septum and/or upper lateral cartilage are mainly responsible for the static internal nasal valve compromise. Characteristic findings include pinching of the middle vault and an inverted V deformity. Widening the nasal valve area is the most preferred therapy to correct statically narrowed nasal valve compromise. External valve compromise, on the other hand, is dynamically collapsible in many cases as evident during respiration. Typical sign, therefore, includes an inward collapse of alar and/or lateral wall upon inhalation. Treatment strategy, in this particular case, usually involves a cartilage addition to the deficient lateral wall or alar in order to stablize and provide rigidity to the lateral wall and also resist inspiratory negative force. However, surgeons should not be confused by the collapse as it may merely reflect the collapsibility of the structure rather than a genuine epicenter of nasal obstruction. Cartilage graft with or without suturing is the best therapeutic measure for patients with either static or dynamic nasal valve compromise when tackling nasal obstruction. It also enhances the structural integrity of the nasal valve. This review focuses on the various surgical techniques used in repairing nasal valve compromise to increase patency and restore breathing with an emphasis on each specific indication. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(4):214-25
Abstract
The nasal valve spans a minimal cross sectional area of the intake point inside the nose. Acting as a Starling’s resistor, it plays a pivotal role in controlling the inspiratory airflow. Nasal valve compromise, better known as nasal valve dysfunction, can be suspected when the patient complains of inspiratory nasal obstruction after trauma or surgery. If the patient has a history highly suspicious of nasal valve compromise, thorough physical examinations are mandatory in order to find the exact epicenter. The deformed L-strut septum and/or upper lateral cartilage are mainly responsible for the static internal nasal valve compromise. Characteristic findings include pinching of the middle vault and an inverted V deformity. Widening the nasal valve area is the most preferred therapy to correct statically narrowed nasal valve compromise. External valve compromise, on the other hand, is dynamically collapsible in many cases as evident during respiration. Typical sign, therefore, includes an inward collapse of alar and/or lateral wall upon inhalation. Treatment strategy, in this particular case, usually involves a cartilage addition to the deficient lateral wall or alar in order to stablize and provide rigidity to the lateral wall and also resist inspiratory negative force. However, surgeons should not be confused by the collapse as it may merely reflect the collapsibility of the structure rather than a genuine epicenter of nasal obstruction. Cartilage graft with or without suturing is the best therapeutic measure for patients with either static or dynamic nasal valve compromise when tackling nasal obstruction. It also enhances the structural integrity of the nasal valve. This review focuses on the various surgical techniques used in repairing nasal valve compromise to increase patency and restore breathing with an emphasis on each specific indication. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(4):214-25
참고문헌 (36)
- Rhee JS, "Clinical consensus statement: diagnosis and management of nasal valve compromise", Otolaryngol Head Neck Surg, 143(1), pp.48~59 (2010)
- Most SP, "Trends in functional rhinoplasty", Arch Facial Plast Surg, 10(6), pp.410~413 (2008)
- Constantlan MB, "Valvular incompetence is most likely cause of postrhinoplasty airway problems", Aesthet Surg J, 18(1), pp.58~60 (1998)
- Ricci E, "Role of nasal valve in the surgically corrected nasal respiratory obstruction:evaluation through rhinomanometry", Am J Rhinol, 15(5), pp.307~310 (2001)
- Heinberg CE, "The Cottle sign: an aid in the physical diagnosis of nasal airflow disturbances", Rhinology, 11, pp.89~94 (1973)
- Park SS, "Revision Rhinoplasty", Thieme-Verlag, pp.52~68 (2008)
- Beeson WH, "The nasal septum", Otolaryngol Clin North Am, 20(4), pp.743~767 (1987)
- 장진순, "기능적 비성형술", 대한이비인후과학회지 두경부외과학, 49(9), pp.876~886 (2006), 대한이비인후과학회
- Sheen JH, "Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty", Plast Reconstr Surg, 73(2), pp.230~239 (1984)
- André RF, "Endonasal spreader graft placement as treatment for internal nasal valve insufficiency: no need to divide the upper lateral cartilages from the septum", Arch Facial Plast Surg, 6(1), pp.36~40 (2004)
- Rohrich RJ, "Use of spreader grafts in the external approach to rhinoplasty", Clin Plast Surg, 23(2), pp.255~262 (1996)
- Friedman O, "Conchal cartilage butterfly graft in primary functional rhinoplasty", Laryngoscope, 119(2), pp.255~262 (2009)
- Clark JM, "The ‘butterfly’ graft in functional secondary rhinoplasty", Laryngoscope, 112(11), pp.117~1925 (2002)
- 김애리, "이개 연골 나비이식(Conchal Cartilage Butterfly Graft)의 술기변형을 통한 양쪽 상외측 비연골 기능 부전 교정의 개선된 수술 방법", 임상이비인후과, 21(2), pp.257~260 (2010), 대한이비인후과학회 부산,울산,경남 지부회[DOI]
- Guyuron B, "Upper lateral splay graft", Plast Reconstr Surg, 102(6), pp.2169~2177 (1998)
- Stucker FJ, "Nasal reconstruction with conchal cartilage. Correcting valve and lateral nasal collapse", Arch Otolaryngol Head Neck Surg, 120(6), pp.653~658 (1994)
- Toriumi DM, "Use of alar batten grafts for correction of nasal valve collapse", Arch Otolaryngol Head Neck Surg, 123(8), pp.802~808 (1997)
- Millman B, "Alar batten grafting for management of the collapsed nasal valve", Laryngoscope, 112(3), pp.574~579 (2002)
- Constantian MB, "Functional effects of alar cartilage malposition", Ann Plast Surg, 30(6), pp.487~499 (1993)
- Gunter JP, "Lateral crural strut graft: technique and clinical applications in rhinoplasty", Plast Reconstr Surg, 99(4), pp.943~952 (1997)
- Weber SM, "Alar cartilage grafts", Clin Plast Surg, 37(2), pp.253~264 (2010)
- Paniello RC, "Nasal valve suspension. An effective treatment for nasal valve collapse", Arch Otolaryngol Head Neck Surg, 122(12), pp.1342~1346 (1996)
- Page MS, "Suspension suture techniques in nasal valve surgery", Facial Plast Surg, 27(5), pp.437~41 (2011)
- Friedman M, "Nasal valve suspension: an improved, simplified technique for nasal valve collapse", Laryngoscope, 113(2), pp.381~385 (2003)
- Lieberman DM, "Lateral nasal wall suspension using a bone-anchored suture technique", Arch Facial Plast Surg, 12(2), pp.113~ (2010)
- Park SS, "The flaring suture to augment the repair of the dysfunctional nasal valve", Plast Reconstr Surg, 101(4), pp.1120~1122 (1998)
- Kim DW, "Management of naso-septal L-strut deformities", Facial Plast Surg, 22(1), pp.9~27 (2006)
- Mau T, "Cadaveric and engineering analysis of the septal L-strut", Laryngoscope, 117(11), pp.1902~1906 (2007)
- Toriumi DM, "Innovative surgical management of the crooked nose", Facial Plast Surg Clin North Am, 1, pp.63~78 (1993)
- Boccieri A, "Septal crossbar graft for the correction of the crooked nose", Plast Reconstr Surg, 111(2), pp.629~638 (2003)
- Gubisch W, "Extracorporeal septoplasty for the markedly deviated septum", Arch Facial Plast Surg, 7(4), pp.218~226 (2005)
- Rohrich RJ, "The deviated nose: optimizing results using a simplified classification and algorithmic approach", Plast Reconstr Surg, 110(6), pp.1509~1523 (2002)
- Armengot M, "Upper lateral cartilage transposition in the surgical management of nasal valve incompetence", Rhinology, 41(2), pp.107~112 (2003)
- Schlosser RJ, "Functional nasal surgery", Otolaryngol Clin North Am, 32(1), pp.37~51 (1999)
- Reynolds MB, "Nasal valve dysfunction after Mohs surgery for skin cancer of the nose", Dermatol Surg, 24(9), pp.1011~1017 (1998)
- Robinson JK, "Nasal valve malfunction resulting from resection of cancer", Arch Otolaryngol Head Neck Surg, 116(12), pp.1419~1424 (1990)