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Zachary M. Soler, MD; Eben Rosenthal, MD; Mark K. Wax, MD, FRCSC

Arch Facial Plast Surg. 2008;10(5):312-315.

Objectives  To highlight the problem of valve collapse after facial paralysis and review the efficacy of performing immediate reconstruction at the time of initial oncologic resection, using a suture technique of suspending the soft tissue of the nasal valve to the inferior orbital rim.

Methods  A review of all patients undergoing immediate nasal valve reconstruction was undertaken. There was a total of 18 patients, 15 men and 3 women, with a median age of 64 years. All patients had undergone facial nerve resection as part of their initial ablative procedure with immediate reconstruction of the nasal valve. A suture technique was used that secured the nasal valve area to the inferior orbital rim periosteum. These patients were compared with a cohort of 10 patients who underwent similar oncologic and reconstructive procedures but had no nasal valve reconstruction.

Results  Patients were evaluated with the Nasal Obstruction Septoplasty Evaluation tool. In patients who underwent reconstruction, there was no evidence of valve collapse on clinical examination. Patients who did not undergo reconstruction demonstrated significantly more symptoms of (1) congestion or stuffiness (1.8 vs 0.4; P < .05), (2) nasal blockage or congestion (2.6 vs 0.3; P < .05), (3) trouble breathing through the nose (2.7 vs 0.3; P < .05); (4) trouble sleeping (2.7 vs 0.3; P < .05); and (5) inability to get enough air during exertion (1.2 vs 0.1; P < .05). Follow-up extended to a median of 2 years. In the reconstructed group, cosmesis was acceptable and there were no instances of suture breakage or granuloma.

Conclusions  We propose that the nasal valve should be addressed at the time of initial facial nerve resection if immediate reconstruction is planned. A suture suspension technique is easily used at the time of primary resection and reconstruction.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University, Portland (Drs Soler and Wax), and University of Alabama at Birmingham (Dr Rosenthal).

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