Trends in Functional Rhinoplasty

  • Joshua D. Weissman
  • Sam P. Most


The evolution of the rhinoplastic surgery has spanned several centuries, with the last few decades focused on the development and refinement of techniques that address the nasal airway specifically. This increased focus on functional rhinoplasty has led to significant improvements in our ability to preserve and augment the nasal airway. Techniques are generally categorized by their effects on the external and/or internal nasal valves. Limitations exist, however, in our ability to critically interpret and apply these techniques due to a dearth of validated and reliable outcomes measures as well as confusion regarding the nomenclature of the nasal valves. This chapter will present a brief introduction to the history of functional rhinoplasty, means of evaluating the nose, outcomes, and surgical treatment of the nasal airway during functional rhinoplasty.


Inferior Turbinate Nasal Valve Lateral Nasal Wall Spreader Graft Lower Lateral Cartilage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Cottle MH (1953) The role of the rhinologist in rhinoplasty. Laryngoscope 63(7):608–618PubMedGoogle Scholar
  2. 2.
    Mink P (1920) Physiologie der Oberen Luftwege. Vogel, LeipzigGoogle Scholar
  3. 3.
    Most SP (2008) Trends in functional rhinoplasty. Arch Facial Plast Surg 10(6):410–413PubMedGoogle Scholar
  4. 4.
    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):802–808PubMedCrossRefGoogle Scholar
  5. 5.
    Rohrich RJ, Hoxworth RE, Thornton JF, Pessa JE (2008) The pyriform ligament. Plast Reconstr Surg 121(1):277–281PubMedCrossRefGoogle Scholar
  6. 6.
    Grymer LF (1995) Reduction rhinoplasty and nasal patency: change in the cross-sectional area of the nose evaluated by acoustic rhinometry. Laryngoscope 105(4 Pt 1):429–431PubMedCrossRefGoogle Scholar
  7. 7.
    Piccirillo JF, Merritt MG Jr, Richards ML (2002) Psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg 126(1):41–47PubMedCrossRefGoogle Scholar
  8. 8.
    Rhee JS, McMullin BT (2008) Outcome measures in facial plastic surgery: patient-reported and clinical efficacy measures. Arch Facial Plast Surg 10(3):194–207PubMedGoogle Scholar
  9. 9.
    Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT (2004) Development and validation of the nasal obstruction symptom evaluation (NOSE) scale. Otolaryngol Head Neck Surg 130(2):157–163PubMedCrossRefGoogle Scholar
  10. 10.
    Stewart MG, Smith TL, Weaver EM, Witsell DL, Yueh B, Hannley MT, Johnson JT (2004) Outcomes after nasal septoplasty: results from the nasal obstruction septoplasty effectiveness (NOSE) study. Otolaryngol Head Neck Surg 130(3):283–290PubMedCrossRefGoogle Scholar
  11. 11.
    Gandomi B, Bayat A, Kazemei T (2009) Outcomes of septoplasty in young adults: the nasal obstruction septoplasty effectiveness study. Am J Otolaryngol 31(3): 189–192PubMedCrossRefGoogle Scholar
  12. 12.
    Rhee JS, Poetker DM, Smith TL, Bustillo A, Burzynski M, Davis RE (2005) Nasal valve surgery improves disease-specific quality of life. Laryngoscope 115(3): 437–440PubMedCrossRefGoogle Scholar
  13. 13.
    Most SP (2006) Analysis of outcomes after functional rhinoplasty using a disease-specific quality-of-life instrument. Arch Facial Plast Surg 8(5):306–309PubMedCrossRefGoogle Scholar
  14. 14.
    Harrill WC, Pillsbury HC 3rd, McGuirt WF, Stewart MG (2007) Radiofrequency turbinate reduction: a NOSE evaluation. Laryngoscope 117(11):1912–1919PubMedCrossRefGoogle Scholar
  15. 15.
    Most SP (2006) Anterior septal reconstruction: outcomes after a modified extracorporeal septoplasty technique. Arch Facial Plast Surg 8(3):202–207PubMedCrossRefGoogle Scholar
  16. 16.
    Roofe SB, Most SP (2007) Placement of a lateral nasal suspension suture via an external rhinoplasty approach. Arch Facial Plast Surg 9(3):214–216PubMedGoogle Scholar
  17. 17.
    Wewers ME, Lowe NK (1990) A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13(4):227–236PubMedCrossRefGoogle Scholar
  18. 18.
    Lam DJ, James KT, Weaver EM (2006) Comparison of anatomic, physiological, and subjective measures of the nasal airway. Am J Rhinol 20(5):463–470PubMedCrossRefGoogle Scholar
  19. 19.
    Rhee JS, Arganbright JM, McMullin BT, Hannley M (2008) Evidence supporting functional rhinoplasty or nasal valve repair: a 25-year systematic review. Otolaryngol Head Neck Surg 139(1):10–20PubMedCrossRefGoogle Scholar
  20. 20.
    Spielmann PM, White PS, Hussain SS (2009) Surgical techniques for the treatment of nasal valve collapse: a systematic review. Laryngoscope 119(7):1281–1290PubMedCrossRefGoogle Scholar
  21. 21.
    Rhee JS (2009) Measuring outcomes in nasal surgery: realities and possibilities. Arch Facial Plast Surg 11(6):416–419PubMedGoogle Scholar
  22. 22.
    Sheen JH (1984) Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 73(2):230–239PubMedCrossRefGoogle Scholar
  23. 23.
    Alsarraf R, Murakami C (1999) The saddle nose deformity. Facial Plast Surg Clin North Am 7: 303–310Google Scholar
  24. 24.
    Byrd HS, Meade RA, Gonyon DL Jr (2007) Using the autospreader flap in primary rhinoplasty. Plast Reconstr Surg 119(6):1897–1902PubMedCrossRefGoogle Scholar
  25. 25.
    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, Epub 2011 Feb 21PubMedCrossRefGoogle Scholar
  26. 26.
    Park SS (1998) The flaring suture to augment the repair of the dysfunctional nasal valve. Plast Reconstr Surg 101(4):1120–1122PubMedCrossRefGoogle Scholar
  27. 27.
    Hage J (1965) Collapsed alae strengthened by conchal cartilage (the butterfly cartilage graft). Br J Plast Surg 18:92–96PubMedCrossRefGoogle Scholar
  28. 28.
    Clark JM, Cook TA (2002) The ‘butterfly’ graft in functional secondary rhinoplasty. Laryngoscope 112(11):1917–1925PubMedCrossRefGoogle Scholar
  29. 29.
    Friedman O, Cook TA (2009) Conchal cartilage butterfly graft in primary functional rhinoplasty. Laryngoscope 119(2):255–262PubMedCrossRefGoogle Scholar
  30. 30.
    Guyuron B, Michelow BJ, Englebardt C (1998) Upper lateral splay graft. Plast Reconstr Surg 102(6): 2169–2177PubMedCrossRefGoogle Scholar
  31. 31.
    Islam A, Arslan N, Felek SA, Celik H, Demirci M, Oguz H (2008) Reconstruction of the internal nasal valve: modified splay graft technique with endonasal approach. Laryngoscope 118(10):1739–1743PubMedCrossRefGoogle Scholar
  32. 32.
    Dutton JM, Neidich MJ (2008) Intranasal Z-plasty for internal nasal valve collapse. Arch Facial Plast Surg 10(3):164–168PubMedGoogle Scholar
  33. 33.
    Schulte DL, Sherris DA, Kern EB (1999) M-plasty correction of nasal valve obstruction. Facial Plast Surg Clin North Am 7(3):405–409Google Scholar
  34. 34.
    Skoog T (1966) A method of hump reduction in rhinoplasty. A technique for preservation of the nasal roof. Arch Otolaryngol 83(3):283–287PubMedCrossRefGoogle Scholar
  35. 35.
    Regnault P, Alfaro A (1980) The Skoog rhinoplasty: a modified technique. Plast Reconstr Surg 66(4): 578–590PubMedCrossRefGoogle Scholar
  36. 36.
    Seren E (2009) A new surgical method of dynamic nasal valve collapse. Arch Otolaryngol Head Neck Surg 135(10):1010–1014PubMedCrossRefGoogle Scholar
  37. 37.
    Gunter JP, Friedman RM (1997) Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 99(4):943–952; discussion 953–955PubMedCrossRefGoogle Scholar
  38. 38.
    Mendelsohn MS, Golchin K (2006) Alar expansion and reinforcement: a new technique to manage nasal valve collapse. Arch Facial Plast Surg 8(5):293–299PubMedCrossRefGoogle Scholar
  39. 39.
    Paniello RC (1996) Nasal valve suspension. An effective treatment for nasal valve collapse. Arch Otolaryngol Head Neck Surg 122(12):1342–1346PubMedCrossRefGoogle Scholar
  40. 40.
    Friedman M, Ibrahim H, Syed Z (2003) Nasal valve suspension: an improved, simplified technique for nasal valve collapse. Laryngoscope 113(2):381–385PubMedCrossRefGoogle Scholar
  41. 41.
    Tellioglu AT, Cimen K (2007) Turn-in folding of the cephalic portion of the lateral crus to support the alar rim in rhinoplasty. Aesthetic Plast Surg 31(3): 306–310PubMedCrossRefGoogle Scholar
  42. 42.
    Murakami CS, Barrera JE, Most SP (2009) Preserving structural integrity of the alar cartilage in aesthetic rhinoplasty using a cephalic turn-in flap. Arch Facial Plast Surg 11(2):126–128PubMedGoogle Scholar
  43. 43.
    Menger DJ (2006) Lateral crus pull-up: a method for collapse of the external nasal valve. Arch Facial Plast Surg 8(5):333–337PubMedCrossRefGoogle Scholar
  44. 44.
    Friedman M, Ibrahim H, Lee G, Joseph NJ (2004) A simplified technique for airway correction at the nasal valve area. Otolaryngol Head Neck Surg 131(4): 519–524PubMedCrossRefGoogle Scholar
  45. 45.
    Menick FJ (1999) Anatomic reconstruction of the nasal tip cartilages in secondary and reconstructive rhinoplasty. Plast Reconstr Surg 104(7):2187–2198; discussion 2199–2201PubMedCrossRefGoogle Scholar
  46. 46.
    Troell RJ, Powell NB, Riley RW, Li KK (2000) Evaluation of a new procedure for nasal alar rim and valve collapse: nasal alar rim reconstruction. Otolaryngol Head Neck Surg 122(2):204–211PubMedCrossRefGoogle Scholar
  47. 47.
    Rohrich RJ, Raniere J Jr, Ha RY (2002) The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg 109(7):2495–2505; discussion 2506–2508PubMedCrossRefGoogle Scholar
  48. 48.
    King ED, Ashley FL (1952) The correction of the internally and externally deviated nose. Plast Reconstr Surg (1946) 10(2):116–120CrossRefGoogle Scholar
  49. 49.
    Gubisch W (2005) Extracorporeal septoplasty for the markedly deviated septum. Arch Facial Plast Surg 7(4):218–226PubMedCrossRefGoogle Scholar
  50. 50.
    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):972–978PubMedCrossRefGoogle Scholar
  51. 51.
    Bhandarkar ND, Smith TL (2010) Outcomes of surgery for inferior turbinate hypertrophy. Curr Opin Otolaryngol Head Neck Surg 18(1):49–53PubMedCrossRefGoogle Scholar
  52. 52.
    Liu CM, Tan CD, Lee FP, Lin KN, Huang HM (2009) Microdebrider-assisted versus radiofrequency-assisted inferior turbinoplasty. Laryngoscope 119(2): 414–418PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Division of Facial Plastic and Reconstructive SurgeryStanford University School of MedicineStanfordUSA

Personalised recommendations