0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Intraoperative Endoscopic Suction–Assisted Evaluation of the Nasal Valve

James C. Marotta, MD1; Kyeesha Becoats, MD2
[+] Author Affiliations
1Marotta Facial Plastic Surgery PC, Smithtown, New York
2Stony Brook University, Smithtown, New York
JAMA Facial Plast Surg. 2016;18(3):171-176. doi:10.1001/jamafacial.2015.2082.
Text Size: A A A
Published online

Importance  The study sought to identify a new method for measuring internal nasal valve patency.

Objective  To determine whether intraoperative endoscopic suction–assisted evaluation of the internal nasal valve is a useful technique to assess internal nasal valve area and function.

Design, Setting, and Participants  A study of 20 patients undergoing cosmetic and functional septorhinoplasty from May 1 through October 31, 2012, at a private surgical practice was performed. A follow-up study was performed 3 years postoperatively on 7 patients. A photograph of the internal nasal valve was taken endoscopically with and without suction preoperatively, postoperatively, and at 3-year follow-up. Measurement of the internal nasal valve surface areas was then performed by an evaluator masked to patient groupings.

Main Outcomes and Measures  Outcome measures were surface area of the internal nasal valve as measured by standardized, endoscopic photography preoperatively, postoperatively, and at 3 years with and without suction and Nasal Obstruction Symptom Evaluation (NOSE) scale scores at 3 years comparing preoperative and postoperative symptoms.

Results  Among the 20 patients studied, 13 were female and the mean age was 26 years. No difference was found in the observed static surface area of the internal nasal valve comparing preoperative and postoperative values (72 418 vs 76 973 square pixels, P = .58). No difference was found in the observed static surface area of the internal nasal valve comparing preoperative (56 426 square pixels) and postoperative (60 011 square pixels) values (P = .58). No difference was found in the observed surface area of the internal nasal valve under negative pressure comparing preoperative (54 194 square pixels) and immediate postoperative (58 325 square pixels) values (P = .97). At 3 years, the resting surface area of the internal nasal valve was not increased with an internal nasal valve surface area mean of 56 426 square pixels preoperatively and 84 352 postoperatively (P = .09). The surface area of the internal nasal valve was increased when exposed to negative sniff pressures in the 3-year follow-up by 45% (P = .03). The surface area measured a mean of 47 683 square pixels preoperatively and 85 612 square pixels at the 3-year mark under negative pressure.

Conclusions and Relevance  The study outlines a novel technique for measuring internal nasal valve surface area and compliance preoperatively and postoperatively. Surgery on the internal nasal valve has a greater effect on the dynamic function of the internal nasal valve (ie, stiffness that can be accounted for by a mere increase in nasal valve size when measured endoscopically). The study lays the groundwork for future studies using this technique.

Level of Evidence  4.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Introduction of the Endoscope

A, The endoscope was introduced to the end of the tape marking at 1.3 cm and consistently at the beginning of the nasal sill. B, Photographs were taken at a consistent distance and magnification with the inferior turbinate at the 7-o’clock position.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Endoscopic Suctioning

A, A puncture hole was made in the suction tubing and the endoscope introduced. B, The end of the suction tubing was placed precisely at 1.3 cm delineated by the tape marking. C, The nasal valve after suction occlusion has a negative inspiratory sniff pressure of 82 mm Hg.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Tracing of the Nasal Valve and Measurement of the Surface Area

The tracing was made with the National Institutes of Health software program ImageJ.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

207 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();