Endonasal placement of spreader grafts: experience in 41 consecutive patients

OBJECTIVES To evaluate the efficacy of placing spreader grafts via an endonasal approach and to examine the immediate and long-term functional results. METHODS A retrospective review was performed of 41 consecutive cases involving adult patients who underwent nasal valve reconstruction. Medical history and clinical examination established the cause of nasal obstruction, with internal valve dysfunction confirmed through endoscopic evaluation and the modified Cottle maneuver. Surgical correction involved a spreader graft harvested from autologous cartilage and placed endonasally. Comparison and evaluation of preoperative vs postoperative symptom severity, photographs, and patient self-assessment were used to quantify the results of the operation. RESULTS Our study included 22 women and 19 men with a mean age (range) of 32 (19-56) years. Twenty-seven patients (66%) were Asian, 12 (29%) were white, and 2 (5%) were Hispanic. Thirty of 41 patients (73%) expressed strong concern regarding the presence of a transcolumellar scar. Among our patients with confirmed internal nasal valve dysfunction, 25 (61%) reported significant improvement, 15 (37%) noted some improvement, and 1 (2%) described no change; none reported a worsening of symptoms. CONCLUSIONS The endonasal approach to placement of spreader grafts for nasal valve reconstruction is effective at relieving nasal obstruction due to internal nasal valve dysfunction. Paramount to the success of the procedure is appropriate patient selection and careful attention to surgical technique.