We present a new method of treatment
for nasal valve dysfunction caused by insufficiency or stenosis in a patient
who refused open septum revision despite a significant degree of septum deviation.
The Anterior Spreader Flap (ASF) technique was suggested as an alternative to
open nasal septum revision and was performed under local anesthesia.
Computational fluid dynamics (CFD) tests
were performed pre- and post-operatively and our patient was asked to complete
a self-assessment using a Visual Analog Scale (VAS) for nasal
breathing (0 = free nasal breathing, 10 = complete nasal blockage) before and
12 months after surgery. The ASF is a minimally invasive endonasal procedure in
which the caudal edge of the upper lateral cartilage is dissected from the
septum, and folded inwards and fixed. The ASF allows for less airflow
resistance and more free space. CFD techniques revealed a reduction in local
pressure based on extended space. In addition, VAS scores improved from 9 to 2
points (right side) and from 8 to 2 points (left side). On the basis of these
findings, the ASF technique can be considered a safe, minimally invasive
spreader flap technique. It can easily
be combined with other nasal surgical techniques, as it is necessary in most
cases. In selected cases, the ASF may be performed as a single procedure
in patients with nasal valve dysfunction caused by septum deviation as an
alternative to open septum revision.
Cite this paper
Bessler, S. , Mende, K. , Goubergrits, L. , Osman, J. and Strub, B. (2014) The Anterior Spreader Flap: A Minimally Invasive Alternative to the Auto Spreader Flap in the Treatment of Patients with Nasal Valve Dysfunction. International Journal of Otolaryngology and Head & Neck Surgery
, 184-189. doi: 10.4236/ijohns.2014.34034
 Wexler, D.B. and Davidson, T.M. (2004) The Nasal Valve: A Review of the Anatomy, Imaging, and Physiology. American Journal of Rhinology, 18, 143-150.
 Mink, P.J. (1920) Physiologie der Oberen Atemwege: Die Nasenhöhle. F.C.W. Vogel, Leipzig.
 Masing, H. (1967) Experimentelle Untersuchungen über die Strömung im Nasenmodell. Arch Klin Exper Ohren-, Nasen-, und Kehlkopfheilk, 189, 59-70.
 André, R.F. and Vuyk, H.D. (2008) Nasal Valve Surgery; Our Experience with the Valve Suspension Technique. Rhinology, 46, 66-69.
 Fischer, H. and Gubisch, W. (2006) Nasal Valves—Importance and Surgical Procedures. Facial Plastic Surgery, 22, 266-280. http://dx.doi.org/10.1055/s-2006-954845
 Fomon, S.G.J. and Caron, A.L. (1950) Collapsed Ala. Acta Otolaryngologica, 51, 465-484. http://dx.doi.org/10.1001/archotol.1950.00700020488001
 Gruber, R.P., Park, E., Newan, J., Berkowitz, L. and Oneal, R. (2007) The Spreader Flap in Primary Rhinoplasty. Plastic and Reconstructive Surgery, 119, 1903-1910. http://dx.doi.org/10.1097/01.prs.0000259198.42852.d4
 Hildebrandt, T., Goubergrits, L., Heppt, W.J., Bessler, S. and Zachow, S. (2013) Evaluation of the Intranasal Flow Field through Computational Fluid Dynamics. Facial Plastic Surgery, 29, 93-98. http://dx.doi.org/10.1055/s-0033-1341591
 De Pochat, V.D., Alonso, N., Mendes, R., Cunha, M.S. and Menezes, J. (2012) Nasal Patency after Open Rhinoplasty with Spreader Grafts. Plastic and Reconstructive Surgery, 65, 732-738. http://dx.doi.org/10.1016/j.bjps.2011.11.059