Anatomical comparison of minimally invasive nasal valve procedures

To determine the quantitative effects of Z-plasty vs spreader grafts on nasal valve surface area.

Eight fresh cadaver heads were used that provided 16 total nasal valve procedures. Surgical sides were randomized, and Z-plasty was performed on 8 valves and endonasal spreader grafts were performed on 8 valves. The minimal cross-sectional area at the level of the nasal valve was measured preoperatively and postoperatively using acoustic rhinometry. We then compared Z-plasty and spreader grafts using a Wilcoxon signed rank test.

The mean nasal surface area at the nasal valve before Z-plasty was 1.37 cm(2) (range, 0.39-2.25 cm(2)) and after Z-plasty was 1.95 cm(2) (range, 1.08-2.62 cm(2)). The mean surface area at the nasal valve before spreader grafts was 1.15 cm(2) (range, 0.75-1.48 cm(2)) and after spreader grafts was 1.48 cm(2) (0.95-1.95 cm(2)). This correlates with a mean increase in the nasal valve surface area of 65% when Z-plasty was performed (95% CI, 28%-88%; P = .007) and 31% when a spreader graft was performed (95% CI, 15%-54%; P = .01).

Z-plasty and spreader grafts were shown to increase nasal valve surface area. Z-plasty seems to increase nasal valve surface area more than spreader grafts.