Surgical techniques for the treatment of nasal valve collapse: a systematic review

To critically evaluate the surgical treatment strategies for nasal valve collapse.

A systematic review of studies to treat nasal valve collapse, using surgical methods, from 1970 to 2008. A search of EBM reviews, MEDLINE, and EMBASE was performed using the following search terms: "nasal valve collapse" AND "alar collapse," "nasal valve insufficiency," "alar insufficiency," and "functional rhinoplasty." The following outcome measures were sought: subjective symptom relief, cosmetic outcome, and objective measurements of nasal airway patency. The following were inclusion criteria: at least 10 patients in each study, stated aim to improve airway obstruction, and a minimum of 1 month follow-up for every patient.

Our search identified 98 papers, which were then retrieved and analyzed. Of these, 43 met the inclusion criteria. No randomized controlled trials exist; one trial presented level IIIb evidence, but all other studies were classed as level IV. Seven authors present objective measurements of nasal airflow or cross-sectional area, and four authors present validated outcome measures.

A variety of focussed surgical techniques are described to deal with nasal valve collapse. We could find no randomized controlled trials on nasal valve surgery. Research in nasal valve surgery is frequently driven by technical description of surgical technique rather than the establishment of evidence of long-term patient benefit. Although our understanding of the role of the nasal valve in the pathophysiology of nasal obstruction has improved vastly, the myriad of surgical techniques described perhaps reflects our uncertainty in choice of technique and in degree of patient benefit.