Monday, May 24, 2010

Minimally invasive surgery in the nasal valve area to treat nasal obstruction

Introduction:

Mink defined nasal valve area to be the narrowest portion of the whole of the nasal cavity. He anatomically characterized this area anatomically as a two dimensional slit like opening lying between the caudal edge of the upper lateral cartilage and the corresponding area of the nasal septum. Deformities involving this area cause troublesome nasal stuffiness and obstruction. Surgical procedure involving this area is fraught with dangers of stenosis in this vital area and deformities involving the contour of the nose. This article describes what could be considered to be a simple surgical procedure that could relieve obstruction in this area.


Procedure:
This procedure can be performed under local anesthesia. Nasal cavity is first packed with ribbon gauze dipped in 4% xylocaine with 1 in 100,000 units adrenaline. Xylocaine in 1% concentration

mixed with 1 in 100,000 units adrenaline is infiltrated over the prominence formed by the caudal portion of the upper lateral cartilage. Parallel incisions are made on either side of the caudal portion of the upper lateral cartilage. The caudal portion of the upper lateral cartilage is exposed after removing a strip of mucosa with the underlying fibrous tissue. A 2 mm cuff of mucosa along with overlying fibrous tissue is also removed to prevent redundant tissue formation. About 1-2 mm of the terminal portion of the upper lateral cartilage should be resected and removed. The wound is closed with absorbable suture like catgut. This procedure is safe to perform bilaterally also if necessary.



This type of minimally invasive surgical procedure releaves the fixed nasal obstruction which is caused by excessive cartilage in this area.





Figure showing the steps of minimally invasive surgery involving the nasal valve area

This technique was first described by Gray in 1970. It was left to Kern (1978) to popularize this procedure. According to Kern goal of this surgery is to reconstruct the normal anatomy of the nasal valve area without increasing the rigidity / collapsibility of the nasal valve area.


This surgical procedure is really helpful in relieving nasal obstruction due to abnormalities in the nasal valve area.

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