Internal Nasal Valve Incompetence Is Effectively Treated Using Batten Graft Functional Rhinoplasty

Introduction. Internal nasal valve incompetence (INVI) has been treated with various surgical methods. Large, single surgeon case series are lacking, meaning that the evidence supporting a particular technique has been deficient. We present a case series using alar batten grafts to reconstruct the internal nasal valve, all performed by the senior author. Methods. Over a 7-year period, 107 patients with nasal obstruction caused by INVI underwent alar batten grafting. Preoperative assessment included the use of nasal strips to evaluate symptom improvement. Visual analogue scale (VAS) assessment of nasal blockage (NB) and quality of life (QOL) both pre- and postoperatively were performed and analysed with the Wilcoxon signed rank test. Results. Sixty-seven patients responded to both pre- and postoperative questionnaires. Ninety-one percent reported an improvement in NB and 88% an improvement in QOL. The greatest improvement was seen at 6 months (median VAS 15？mm and 88？mm resp., with a P value of <0.05 for both). Nasal strips were used preoperatively and are a useful tool in predicting patient operative success in both NB and QOL (odds ratio 2.15 and 2.58, resp.). Conclusions. Alar batten graft insertion as a single technique is a valid technique in treating INVI and produces good outcomes. 1. Introduction Internal nasal valve incompetence (INVI) is an often overlooked cause of nasal obstruction which in turn can mistakenly be attributed to other anatomical variations such as septal deviation and turbinate hypertrophy. It is characterised by the collapse during inspiration of the upper lateral cartilages; a narrowing of the angle between the dorsal septum and upper laterals can also contribute but to a lesser extent. Functional rhinoplasty procedures for INVI have evolved over the past decade. A wide range of techniques exists in which surgeons use alar batten and/or spreader grafts, butterfly grafts, lateral crural strut grafts, alar rim grafts [1], and lateral suspension sutures. Alar batten grafts were first shown by Toriumi et al. [2] as an effective technique for correction of internal nasal valve collapse. Since then they have been widely used, but a reliable case series has yet to be published. Case-based series assessing specific techniques are not widely available. When single-technique series are published, they often concentrate on the cosmetic outcomes. Series are usually small [3] and involve several operating surgeons [4] without specific outcomes. Recent papers have called for a single technique by a single operating surgeon to be assessed