Skip to main content

Advertisement

SpringerLink
Log in

Nasal Obstruction and Rhinoplasty: A Focused Literature Review

  • Review
  • Rhinoplasty
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

There is a significant variation in the assessment, treatment, and outcomes of nasal airway obstruction and management in the published literature. This study aimed to: (1) define key components of the nasal airway, (2) identify frequent causes of nasal obstruction, and (3) review existing treatment methods.

Methods

A systematic review of the literature was performed, and 135 studies were included via the following criteria: English, human subjects, and a primary endpoint of nasal airway improvement. Exclusion criteria were: abstract only, no airway data, pediatric patients, cleft rhinoplasty, sleep apnea, isolated traumatic nasal reconstruction, and cadaveric-only or animal studies.

Results

The relevant obstructive sites include the ENV, septum, inferior turbinates, INV, and nasal bones. Addressing the alar rim alone may be insufficient, and inspection of the lateral wall and crura may be indicated. Correction of septal deviation involves attention to the bony base. Mucosal sparing treatment of inferior turbinates improves outcomes. INVs are a major source of nasal obstruction, and treatment includes spreader grafts. The bony nasal vault can contribute to nasal obstruction, including due to surgical osteotomies.

Conclusions

Anatomic causes of airway obstruction include the alar rims and lateral nasal walls, deviated nasal septum, inferior turbinate hypertrophy, decreased INV angle, and narrowed nasal bones. Treatments include graft placement; septoplasty; mucosal sparing turbinectomy; and lateral wall support. Pitfalls include failing to address the bony septum, over-resection of inferior turbinates, and narrowing of the nasal vault. Appreciation of airway management during rhinoplasty will improve functional outcomes.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

source of the nasal airway

Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Teichgraeber JF, Gruber RP, Tanna N (2016) Surgical management of nasal airway obstruction. Clin Plast Surg 43(1):41–46

    PubMed  Google Scholar 

  2. Constantian MB, Clardy RB (1996) The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty (Discussion 55–58). Plast Reconstr Surg 98(1):38–54

    CAS  PubMed  Google Scholar 

  3. Sowder JC, Thomas AJ, Ward PD (2017) Essential anatomy and evaluation for functional rhinoplasty. Facial Plast Surg Clin North Am 25(2):141–160

    PubMed  Google Scholar 

  4. Ghosh A, Friedman O (2016) Surgical treatment of nasal obstruction in rhinoplasty. Clin Plast Surg 43(1):29–40

    PubMed  Google Scholar 

  5. Ustun GG, Ozturk S, Gursoy K, Ergun E, Dag O, Kocer U (2019) Major structural airway pathologies of patient complaining nasal obstruction: analysis of frequency, preoperative complaints and benefit from surgery. J Craniofac Surg 30(5):1479–1483

    PubMed  Google Scholar 

  6. Friedman O, Cekic E, Gunel C (2017) Functional rhinoplasty. Facial Plast Surg Clin North Am 25(2):195–199

    PubMed  Google Scholar 

  7. Afifi AM et al (2015) Evaluating current functional airway surgery during rhinoplasty: a survey of the American Society of Plastic Surgeons. Aesthetic Plast Surg 39(2):181–190

    PubMed  Google Scholar 

  8. Burstein FD (2008) Prevention and correction of airway compromise in rhinoplasty. Ann Plast Surg 61(6):595–600

    CAS  PubMed  Google Scholar 

  9. Tanna N et al (2018) Evidence-based medicine: current practices in rhinoplasty. Plast Reconstr Surg 141(1):137e–151e

    CAS  PubMed  Google Scholar 

  10. Constantian MB (2012) What motivates secondary rhinoplasty? A study of 150 consecutive patients. Plast Reconstr Surg 130(3):667–678

    CAS  PubMed  Google Scholar 

  11. Justicz N, Gadkaree SK, Fuller JC, Locascio JJ, Lindsay RW (2019) Preoperative characteristics of over 1300 functional septorhinoplasty patients. Laryngoscope 130(1):25–31

    PubMed  Google Scholar 

  12. Neligan P, Warren RJ, Van Beek A (2017) Plastic surgery, 4th edn. Elsevier, London, p 6

    Google Scholar 

  13. Thorne C, Grabb WC, Smith JW (2007) Grabb and Smith's plastic surgery, 6th edn. Wolters Kluwer Health, Philadelphia

    Google Scholar 

  14. Yeung A, Hassouneh B, Kim DW (2016) Outcome of nasal valve obstruction after functional and aesthetic-functional rhinoplasty. JAMA Facial Plast Surg 18(2):128–34

    PubMed  Google Scholar 

  15. Rohrich RJ, Krueger JK, Adams WP Jr, Marple BF (2001) Rationale for submucous resection of hypertrophied inferior turbinates in rhinoplasty: an evolution (Discussion 545–546). Plast Reconstr Surg 108(2):536–544

    CAS  PubMed  Google Scholar 

  16. Deylamipour M, Azarhoshangh A, Karimi H (2005) Reconstruction of the internal nasal valve with a splay conchal graft (Discussion 721–722). Plast Reconstr Surg 116(3):712–720

    CAS  PubMed  Google Scholar 

  17. Palesy T, Pratt E, Mrad N, Marcells GN, Harvey RJ (2015) Airflow and patient-perceived improvement following rhinoplastic correction of external nasal valve dysfunction. JAMA Facial Plast Surg 17(2):131–136

    PubMed  Google Scholar 

  18. Doty RL, Frye R (1989) Influence of nasal obstruction on smell function. Otolaryngol Clin North Am 22(2):397–411

    CAS  PubMed  Google Scholar 

  19. Howard BK, Rohrich RJ (2002) Understanding the nasal airway: principles and practice (quiz 1145–1146). Plast Reconstr Surg 109(3):1128–1146

    PubMed  Google Scholar 

  20. VanKoevering KK, Rosko AJ, Moyer JS (2017) Osteotomies demystified. Facial Plast Surg Clin North Am 25(2):201–210

    PubMed  Google Scholar 

  21. Bohluli B, Varedi P, Kahali R, Bagheri SC (2015) External Nasal Valve Efficacy Index: a simple test to evaluate the external nasal valve. Int J Oral Maxillofac Surg 44(10):1240–1245

    CAS  PubMed  Google Scholar 

  22. Rhee JS, Cannon DE, Frank DO, Kimbell JS (2012) Role of virtual surgery in preoperative planning: assessing the individual components of functional nasal airway surgery. Arch Facial Plast Surg 14(5):354–359

    PubMed  PubMed Central  Google Scholar 

  23. Spataro E, Most SP (2018) Measuring nasal obstruction outcomes. Otolaryngol Clin North Am 51(5):883–895

    PubMed  Google Scholar 

  24. Tompos T, Garai T, Zemplen B, Gerlinger I (2010) Sensation of nasal patency compared to rhinomanometric results after septoplasty. Eur Arch Otorhinolaryngol 267(12):1887–1891

    PubMed  Google Scholar 

  25. Ricci E et al (2001) Role of nasal valve in the surgically corrected nasal respiratory obstruction: evaluation through rhinomanometry. Am J Rhinol 15(5):307–310

    CAS  PubMed  Google Scholar 

  26. Ziai H, Bonaparte JP (2018) Reliability and construct validity of the Ottawa valve collapse scale when assessing external nasal valve collapse. J Otolaryngol Head Neck Surg 47(1):15

    PubMed  PubMed Central  Google Scholar 

  27. Murrell GL (2014) Correlation between subjective and objective results in nasal surgery. Aesthet Surg J 34(2):249–257

    PubMed  Google Scholar 

  28. Rhee JS, Sullivan CD, Frank DO, Kimbell JS, Garcia GJ (2014) A systematic review of patient-reported nasal obstruction scores: defining normative and symptomatic ranges in surgical patients (quiz 232). JAMA Facial Plast Surg 16(3):219–225

    PubMed  PubMed Central  Google Scholar 

  29. Rhee JS et al (2010) Clinical consensus statement: diagnosis and management of nasal valve compromise. Otolaryngol Head Neck Surg 143(1):48–59

    PubMed  PubMed Central  Google Scholar 

  30. Sokoya M, Gonzalez JR, Winkler AA (2018) Effect of allergic rhinitis on nasal obstruction outcomes after functional open septorhinoplasty. Am J Otolaryngol 39(3):303–306

    Article  PubMed  Google Scholar 

  31. Barham HP, Knisely A, Christensen J, Sacks R, Marcells GN, Harvey RJ (2015) Costal cartilage lateral crural strut graft vs cephalic crural turn-in for correction of external valve dysfunction. JAMA Facial Plast Surg 17(5):340–345

    Article  PubMed  Google Scholar 

  32. Gunter JP, Friedman RM (1997) Lateral crural strut graft: technique and clinical applications in rhinoplasty (Discussion 953–955). Plast Reconstr Surg 99(4):943–952

    Article  CAS  PubMed  Google Scholar 

  33. Sufyan AS, Hrisomalos E, Kokoska MS, Shipchandler TZ (2013) The effects of alar batten grafts on nasal airway obstruction and nasal steroid use in patients with nasal valve collapse and nasal allergic symptoms: a prospective study. JAMA Facial Plast Surg 15(3):182–186

    Article  PubMed  Google Scholar 

  34. Cervelli V et al (2009) Alar batten cartilage graft: treatment of internal and external nasal valve collapse. Aesthetic Plast Surg 33(4):625–634

    Article  PubMed  Google Scholar 

  35. Kalan A, Kenyon GS, Seemungal TA (2001) Treatment of external nasal valve (alar rim) collapse with an alar strut. J Laryngol Otol 115(10):788–791

    Article  CAS  PubMed  Google Scholar 

  36. Cochran CS, Sieber DA (2017) Extended alar contour grafts: an evolution of the lateral crural strut graft technique in rhinoplasty. Plast Reconstr Surg 140(4):559e–567e

    Article  CAS  PubMed  Google Scholar 

  37. Gassner HG, Maneschi P, Haubner F (2014) The stairstep graft: an alternative technique in nasal valve surgery. JAMA Facial Plast Surg 16(6):440–443

    Article  PubMed  Google Scholar 

  38. Bertossi D, Walter C, Nocini PF (2014) The pull-up spreader high (PUSH) technique for nasal tip support. Aesthet Surg J 34(8):1153–1161

    Article  PubMed  Google Scholar 

  39. Rohrich RJ, Ahmad J (2016) A Practical approach to rhinoplasty. Plast Reconstr Surg 137(4):725e–746e

    Article  CAS  PubMed  Google Scholar 

  40. Rosenberger ES, Toriumi DM (2016) Controversies in revision rhinoplasty. Facial Plast Surg Clin North Am 24(3):337–345

    Article  PubMed  Google Scholar 

  41. Gruber RP, Melkun ET, Strawn JB (2011) External valve deformity: correction by composite flap elevation and mattress sutures. Aesthetic Plast Surg 35(6):960–964

    Article  PubMed  Google Scholar 

  42. Boccieri A, Marianetti TM (2010) Barrel roll technique for the correction of long and concave lateral crura. Arch Facial Plast Surg 12(6):415–421

    Article  PubMed  Google Scholar 

  43. Timperley D, Stow N, Srubiski A, Harvey R, Marcells G (2010) Functional outcomes of structured nasal tip refinement. Arch Facial Plast Surg 12(5):298–304

    Article  PubMed  Google Scholar 

  44. Mendelsohn MS, Golchin K (2006) Alar expansion and reinforcement: a new technique to manage nasal valve collapse. Arch Facial Plast Surg 8(5):293–299

    Article  PubMed  Google Scholar 

  45. Slavit DH, Lipton RJ, Kern EB, McCaffrey TV (1990) Rhinolift operation in the treatment of the aging nose. Otolaryngol Head Neck Surg 103(3):462–467

    Article  CAS  PubMed  Google Scholar 

  46. Ochi JW, de Werd DL (1988) Surgery for bilateral nasal valvular collapse. Rhinology 26(2):105–110

    CAS  PubMed  Google Scholar 

  47. Gunter JP, Landecker A, Cochran CS (2006) Frequently used grafts in rhinoplasty: nomenclature and analysis. Plast Reconstr Surg 118(1):14e–29e

    Article  PubMed  CAS  Google Scholar 

  48. Gassner HG (2010) Structural grafts and suture techniques in functional and aesthetic rhinoplasty. GMS Curr Top Otorhinolaryngol Head Neck Surg 9:c01

    Google Scholar 

  49. Toriumi DM, Josen J, Weinberger M, Tardy ME Jr (1997) Use of alar batten grafts for correction of nasal valve collapse. Arch Otolaryngol Head Neck Surg 123(8):802–808

    Article  CAS  PubMed  Google Scholar 

  50. Orlando GJ, Marquez E (2019) Alar rim reconstruction with autologous graft cartilage: external approach. J Craniofac Surg 30(3):868–870

    PubMed  Google Scholar 

  51. Hamra ST (1993) Repositioning the lateral alar crus. Plast Reconstr Surg 92(7):1244–1253

    CAS  PubMed  Google Scholar 

  52. Sheen JH, Sheen AP, Kavanau H (1987) Aesthetic rhinoplasty, 2nd, ed edn. Mosby, St. Louis

    Google Scholar 

  53. Romo T 3rd, Sclafani AP, Jacono AA (2000) Nasal reconstruction using porous polyethylene implants. Facial Plast Surg 16(1):55–61

    PubMed  Google Scholar 

  54. Benoit A, Hollmig ST, Leach BC (2017) The nasal tip rotation flap for reconstruction of the lateral nasal tip, anterior Ala, and soft triangle: the authors' experience with 55 patients. Dermatol Surg 43(10):1221–1232

    CAS  PubMed  Google Scholar 

  55. Pan BS, Vu AT, Rapp SJ, Saenger NJ (2017) Reconstruction of the isolated columellar defect: a novel 2-stage technique and review of the literature. J Oral Maxillofac Surg 75(4):822–827

    PubMed  Google Scholar 

  56. Sufyan A, Ziebarth M, Crousore N, Berguson T, Kokoska MS (2012) Nasal batten grafts: are patients satisfied? Arch Facial Plast Surg 14(1):14–19

    PubMed  Google Scholar 

  57. Ballert JA, Park SS (2008) Functional considerations in revision rhinoplasty. Facial Plast Surg 24(3):348–357

    CAS  PubMed  Google Scholar 

  58. Constantine FC, Ahmad J, Geissler P, Rohrich RJ (2014) Simplifying the management of caudal septal deviation in rhinoplasty. Plast Reconstr Surg 134(3):379e–388e

    CAS  PubMed  Google Scholar 

  59. Kandathil CK, Spataro EA, Laimi K, Moubayed SP, Most SP, Saltychev M (2018) Repair of the lateral nasal wall in nasal airway obstruction: a systematic review and meta-analysis. JAMA Facial Plast Surg 20(4):307–313

    Article  PubMed  PubMed Central  Google Scholar 

  60. Samra S, Steitz JT, Hajnas N, Toriumi DM (2018) Surgical management of nasal valve collapse. Otolaryngol Clin North Am 51(5):929–944

    PubMed  Google Scholar 

  61. Racy E, Fanous A, Pressat-Laffouilhere T, Benmoussa N (2019) The modified Sliding Alar Cartilage (SAC) flap: a novel way to preserve the internal nasal valve as illustrated by 3D modelling. Plast Reconstr Surg 144(3):593–599

    CAS  PubMed  Google Scholar 

  62. Ozmen S et al (2009) Sliding alar cartilage (SAC) flap: a new technique for nasal tip surgery. Ann Plast Surg 63(5):480–485

    CAS  PubMed  Google Scholar 

  63. Heppt H, Vent J, Alali M, Paal C, Heppt W (2019) Nasal valve lift in nasal valve stenosis-a 2 years clinical trial. Facial Plast Surg 35(1):14–22

    CAS  PubMed  Google Scholar 

  64. Ozkececi G et al (2016) The effect of septoplasty on pulmonary artery pressure and right ventricular function in nasal septum deviation. Eur Arch Otorhinolaryngol 273(11):3747–3752

    PubMed  Google Scholar 

  65. Fidan V, Aksakal E (2011) Impact of septoplasty on pulmonary artery pressure in patients with markedly deviated septum. J Craniofac Surg 22(5):1591–1593

    PubMed  Google Scholar 

  66. Teixeira J, Certal V, Chang ET, Camacho M (2016) Nasal septal deviations: a systematic review of classification systems. Plast Surg Int 2016:7089123

    PubMed  PubMed Central  Google Scholar 

  67. Simon P, Sidle D (2012) Augmenting the nasal airway: beyond septoplasty. Am J Rhinol Allergy 26(4):326–331

    PubMed  PubMed Central  Google Scholar 

  68. Moubayed SP, Most SP (2016) The autospreader flap for midvault reconstruction following dorsal hump resection. Facial Plast Surg 32(1):36–41

    CAS  PubMed  Google Scholar 

  69. Gwanmesia I, Couto R, Papay F (2015) A cadaveric study comparing the efficacy of the sheen spreader graft and the fulcrum spreader graft: part 1. Plast Reconstr Surg 136(4):669–676

    CAS  PubMed  Google Scholar 

  70. Giacomini P, Lanciani R, Di Girolamo S, Ferraro S, Ottaviani F (2010) Caudal septal deviation correction by interlocked graft technique. Ann Plast Surg 65(3):280–284

    CAS  PubMed  Google Scholar 

  71. Prado A, Andrades P, Guerra C, Wisnia P (2008) Cortical and partially cancellous bone spreader grafts: an alternative for the treatment of cartilage-depleted noses. Plast Reconstr Surg 121(6):2136–2141

    CAS  PubMed  Google Scholar 

  72. Mendelsohn M (2005) Straightening the crooked middle third of the nose: using porous polyethylene extended spreader grafts. Arch Facial Plast Surg 7(2):74–80

    PubMed  Google Scholar 

  73. Cerkes N (2011) The crooked nose: principles of treatment. Aesthet Surg J 31(2):241–257

    PubMed  Google Scholar 

  74. Rohrich RJ, Gunter JP, Deuber MA, Adams WP Jr (2002) The deviated nose: optimizing results using a simplified classification and algorithmic approach. Plast Reconstr Surg 110(6):1509–23

    PubMed  Google Scholar 

  75. Metzinger SE, Boyce RG, Rigby PL, Joseph JJ, Anderson JR (1994) Ethmoid bone sandwich grafting for caudal septal defects. Arch Otolaryngol Head Neck Surg 120(10):1121–1125

    CAS  PubMed  Google Scholar 

  76. Constantian MB (1989) An algorithm for correcting the asymmetrical nose. Plast Reconstr Surg 83(5):801–811

    CAS  PubMed  Google Scholar 

  77. Gubisch W (1995) The extracorporeal septum plasty: a technique to correct difficult nasal deformities. Plast Reconstr Surg 95(4):672–682

    CAS  PubMed  Google Scholar 

  78. Peer LA (1937) An operation to repair lateral displacement of the lower border of the septal cartilage. Arch Otolaryngol 25(4):475–477

    Google Scholar 

  79. Hahn S, Becker DG (2014) What are some tips and pearls for preserving and improving nasal function when performing a cosmetic rhinoplasty? Curr Opin Otolaryngol Head Neck Surg 22(1):58–62

    PubMed  Google Scholar 

  80. Ammar SM, Westreich RW, Lawson W (2006) Fan septoplasty for correction of the internally and externally deviated nose. Arch Facial Plast Surg 8(3):213–216

    CAS  PubMed  Google Scholar 

  81. Ghaisas V, Parab SR (2015) Role of extracorporeal septoplasty in deviated noses. Indian J Otolaryngol Head Neck Surg 67(3):205–209

    PubMed  PubMed Central  Google Scholar 

  82. Moubayed SP, Most SP (2017) Correcting deviations of the lower third of the nose. Facial Plast Surg 33(2):157–161

    CAS  PubMed  Google Scholar 

  83. Gevorgyan A, Smith O (2013) Correcting a bent septum by a k-wire stabilization during an extracorporeal septal reconstruction. Aesthetic Plast Surg 37(4):698–703

    PubMed  Google Scholar 

  84. Most SP (2006) Anterior septal reconstruction: outcomes after a modified extracorporeal septoplasty technique. Arch Facial Plast Surg 8(3):202–207

    PubMed  Google Scholar 

  85. Yazar M, Yazar SK, Kozanoglu E, Diyarbakirlioglu M, Eren HI (2017) Use of turn-in skin flaps for nasal lining reconstruction. Dermatol Surg 43(10):1208–1212

    CAS  PubMed  Google Scholar 

  86. Collins JB, Czerwinski M (2015) Contralateral dorsally based septal mucoperichondrial page flap, for nasal lining reconstruction. J Craniofac Surg 26(4):1352–1354

    PubMed  Google Scholar 

  87. Passali D et al (2017) Surgical treatment of nasal septal perforations: SIR (Italian Society of Rhinology) experts opinion. Acta Otorrinolaringol Esp 68(4):191–196

    PubMed  Google Scholar 

  88. Zenga J, Chi JJ (2017) Reconstruction of the intranasal lining. Facial Plast Surg 33(1):67–73

    CAS  PubMed  Google Scholar 

  89. Sillers MJ, Cox AJ, Kulbersh B (2009) Revision septoplasty. Otolaryngol Clin North Am 42(2):261–278

    PubMed  Google Scholar 

  90. Rohrich RJ, Adams WP, Ahmad J, Gunter JP (2014) Dallas rhinoplasty : nasal surgery by the masters Third, edition edn. Quality Medical Publishing, Inc., St. Louis

    Google Scholar 

  91. Lavinsky-Wolff M et al (2013) Effect of turbinate surgery in rhinoseptoplasty on quality-of-life and acoustic rhinometry outcomes: a randomized clinical trial. Laryngoscope 123(1):82–89

    PubMed  Google Scholar 

  92. Feldman EM, Koshy JC, Chike-Obi CJ, Hatef DA, Bullocks JM, Stal S (2010) Contemporary techniques in inferior turbinate reduction: survey results of the American Society for Aesthetic Plastic Surgery. Aesthet Surg J 30(5):672–679

    PubMed  Google Scholar 

  93. Wolfswinkel EM, Koshy JC, Kaufman Y, Sharabi SE, Hollier LH Jr, Edmonds JL (2010) A modified technique for inferior turbinate reduction: the integration of coblation technology. Plast Reconstr Surg 126(2):489–491

    CAS  PubMed  Google Scholar 

  94. Cavaliere M, Mottola G, Iemma M (2005) Comparison of the effectiveness and safety of radiofrequency turbinoplasty and traditional surgical technique in treatment of inferior turbinate hypertrophy. Otolaryngol Head Neck Surg 133(6):972–978

    PubMed  Google Scholar 

  95. Paniello RC (1996) Nasal valve suspension. An effective treatment for nasal valve collapse. Arch Otolaryngol Head Neck Surg 122(12):1342–1346

    CAS  PubMed  Google Scholar 

  96. Kastl KG, Rettinger G, Keck T (2009) The impact of nasal surgery on air-conditioning of the nasal airways. Rhinology 47(3):237–241

    PubMed  Google Scholar 

  97. Barham HP, Thornton MA, Knisely A, Marcells GN, Harvey RJ, Sacks R (2016) Long-term outcomes in medial flap inferior turbinoplasty are superior to submucosal electrocautery and submucosal powered turbinate reduction. Int Forum Allergy Rhinol 6(2):143–147

    PubMed  Google Scholar 

  98. Rohrich RJ, McKee D, Malafa M (2015) Closed microfracture technique for surgical correction of inferior turbinate hypertrophy in rhinoplasty: safety and technical considerations. Plast Reconstr Surg 136(5):607e–e611

    CAS  PubMed  Google Scholar 

  99. Talmadge J, Nayak JV, Yao W, Citardi MJ (2019) Management of postsurgical empty nose syndrome. Facial Plast Surg Clin North Am 27(4):465–475

    PubMed  Google Scholar 

  100. Houser SM (2007) Surgical treatment for empty nose syndrome. Arch Otolaryngol Head Neck Surg 133(9):858–863

    PubMed  Google Scholar 

  101. Li C et al (2017) Computational fluid dynamics and trigeminal sensory examinations of empty nose syndrome patients. Laryngoscope 127(6):E176–E184

    PubMed  PubMed Central  Google Scholar 

  102. Passali D, Passali FM, Damiani V, Passali GC, Bellussi L (2003) Treatment of inferior turbinate hypertrophy: a randomized clinical trial. Ann Otol Rhinol Laryngol 112(8):683–688

    PubMed  Google Scholar 

  103. Coste A, Dessi P, Serrano E (2012) Empty nose syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 129(2):93–97

    CAS  PubMed  Google Scholar 

  104. Borchard NA, Dholakia SS, Yan CH, Zarabanda D, Thamboo A, Nayak JV (2019) Use of intranasal submucosal fillers as a transient implant to alter upper airway aerodynamics: implications for the assessment of empty nose syndrome. Int Forum Allergy Rhinol 9(6):681–687

    PubMed  Google Scholar 

  105. Mink PJ (1903) Le nex comme vol repiratorie. Otolaryngol Belg 21:481–496

    Google Scholar 

  106. Bridger GP (1970) Physiology of the nasal valve. Arch Otolaryngol 92(6):543–553

    CAS  PubMed  Google Scholar 

  107. Hurbis CG (2006) An adjustable, butterfly-design, titanium-expanded polytetrafluoroethylene implant for nasal valve dysfunction: a pilot study. Arch Facial Plast Surg 8(2):98–104

    PubMed  Google Scholar 

  108. Gurlek A, Celik M, Fariz A, Ersoz-Ozturk A, Eren AT, Tenekeci G (2006) The use of high-density porous polyethylene as a custom-made nasal spreader graft. Aesthetic Plast Surg 30(1):34–41

    PubMed  Google Scholar 

  109. Stal S, Hollier L (2000) The use of resorbable spacers for nasal spreader grafts. Plast Reconstr Surg 106(4):922–928

    CAS  PubMed  Google Scholar 

  110. Geissler PJ, Roostaeian J, Lee MR, Unger JJ, Rohrich RJ (2014) Role of upper lateral cartilage tension spanning suture in restoring the dorsal aesthetic lines in rhinoplasty. Plast Reconstr Surg 133(1):7e–11e

    CAS  PubMed  Google Scholar 

  111. Zijlker TD, Quaedvlieg PC (1994) Lateral augmentation of the middle third of the nose with autologous cartilage in nasal valve insufficiency. Rhinology 32(1):34–41

    CAS  PubMed  Google Scholar 

  112. Schlosser RJ, Park SS (1999) Surgery for the dysfunctional nasal valve. Cadaveric analysis and clinical outcomes. Arch Facial Plast Surg. 1(2):105–110

    CAS  PubMed  Google Scholar 

  113. Mamanov M, Batioglu-Karaaltin A, Inci E, Erdur ZB (2017) Effect of spreader graft on nasal functions in septorhinoplasty surgery. J Craniofac Surg 28(7):e618–e621

    PubMed  Google Scholar 

  114. Saedi B, Amali A, Gharavis V, Yekta BG, Most SP (2014) Spreader flaps do not change early functional outcomes in reduction rhinoplasty: a randomized control trial. Am J Rhinol Allergy 28(1):70–74

    PubMed  Google Scholar 

  115. Yoo S, Most SP (2011) Nasal airway preservation using the autospreader technique: analysis of outcomes using a disease-specific quality-of-life instrument. Arch Facial Plast Surg 13(4):231–233

    PubMed  Google Scholar 

  116. Stucker FJ, Lian T, Karen M (2002) Management of the keel nose and associated valve collapse. Arch Otolaryngol Head Neck Surg 128(7):842–846

    PubMed  Google Scholar 

  117. Clark JM, Cook TA (2002) The 'butterfly' graft in functional secondary rhinoplasty. Laryngoscope 112(11):1917–1925

    PubMed  Google Scholar 

  118. Friedman O, Coblens O (2016) The conchal cartilage butterfly graft. Facial Plast Surg 32(1):42–48

    CAS  PubMed  Google Scholar 

  119. Gorgulu T, Ozer CM, Kargi E (2015) The accordion suture technique: a modified rhinoplasty spreader flap. J Craniomaxillofac Surg 43(6):796–802

    PubMed  Google Scholar 

  120. Rizvi SS, Gauthier MG (2011) Lateralizing the collapsed nasal valves simplified: 10-year survey of a simple concealed suture technique. Laryngoscope 121(3):558–561

    PubMed  Google Scholar 

  121. Lee DS, Glasgold AI (2001) Correction of nasal valve stenosis with lateral suture suspension. Arch Facial Plast Surg 3(4):237–240

    CAS  PubMed  Google Scholar 

  122. Jalali MM (2015) Comparison of effects of spreader grafts and flaring sutures on nasal airway resistance in rhinoplasty. Eur Arch Otorhinolaryngol 272(9):2299–2303

    PubMed  Google Scholar 

  123. Guyuron B (1998) Nasal osteotomy and airway changes. Plast Reconstr Surg 102(3):856–860

    CAS  PubMed  Google Scholar 

  124. Most SP, Murakami CS (2005) A modern approach to nasal osteotomies. Facial Plast Surg Clin North Am 13(1):85–92

    PubMed  Google Scholar 

  125. Ghanaatpisheh M, Sajjadian A, Daniel RK (2015) Superior rhinoplasty outcomes with precise nasal osteotomy: an individualized approach for maintaining function and achieving aesthetic goals. Aesthet Surg J 35(1):28–39

    PubMed  Google Scholar 

  126. Robin TP et al (2017) A comprehensive comparative analysis of treatment modalities for sinonasal malignancies. Cancer 123(16):3040–3049

    CAS  PubMed  PubMed Central  Google Scholar 

  127. Eggesbo HB (2012) Imaging of sinonasal tumours. Cancer Imaging 12:136–152

    PubMed  Google Scholar 

  128. Kim DW, Rodriguez-Bruno K (2009) Functional rhinoplasty. Facial Plast Surg Clin North Am 17(1):115–31

    PubMed  Google Scholar 

  129. Ishii LE et al (2017) Clinical practice guideline: improving nasal form and function after rhinoplasty executive summary. Otolaryngol Head Neck Surg 156(2):205–219

    PubMed  Google Scholar 

  130. Daniel RK (2018) The preservation rhinoplasty: a new rhinoplasty revolution. Aesthet Surg J 38(2):228–229

    PubMed  Google Scholar 

  131. Sheen JH (2000) Rhinoplasty: personal evolution and milestones. Plast Reconstr Surg 105(5):1820–1852

    CAS  PubMed  Google Scholar 

  132. Goudakos JK, Daskalakis D, Patel K (2017) Revision rhinoplasty: retrospective chart review analysis of deformities and surgical maneuvers in patients with nasal airway obstruction-five years of experience. Facial Plast Surg 33(3):334–338

    CAS  PubMed  Google Scholar 

  133. Most SP (2006) Analysis of outcomes after functional rhinoplasty using a disease-specific quality-of-life instrument. Arch Facial Plast Surg 8(5):306–309

    PubMed  Google Scholar 

  134. Lee M, Zwiebel S, Guyuron B (2013) Frequency of the preoperative flaws and commonly required maneuvers to correct them: a guide to reducing the revision rhinoplasty rate. Plast Reconstr Surg 132(4):769–776

    CAS  PubMed  Google Scholar 

  135. Okland TS, Kandathil C, Sanan A, Rudy S, Most SP (2019) Analysis of Nasal Obstruction Patterns Following Reductive Rhinoplasty. Aesthetic Plast Surg 44(1):122–128

    PubMed  Google Scholar 

Download references

Funding

The authors have nothing to disclose, and no funding was received for this article.

Author information

Authors and Affiliations

  1. Hurwitz Center for Plastic Surgery, Pittsburgh, PA, 15313, USA

    Lauren Wright

  2. University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, 44106, USA

    Katherine A. Grunzweig

  3. MetroHealth System, Case Western Reserve University, Cleveland, OH, 44113, USA

    Ali Totonchi

Authors
  1. Lauren Wright
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katherine A. Grunzweig
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ali Totonchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ali Totonchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest. Dr. Totonchi and Dr. Grunzweig are members of the Editorial Board for Aesthetic Plastic Surgery.

Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video 1: Powered turbinoplasty using StraightShot®Microdebrider (MP4 7589 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wright, L., Grunzweig, K.A. & Totonchi, A. Nasal Obstruction and Rhinoplasty: A Focused Literature Review. Aesth Plast Surg 44, 1658–1669 (2020). https://doi.org/10.1007/s00266-020-01710-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-020-01710-5

Keywords

Search

Navigation