title: Endoscopic placement of spreader grafts in the nasal valve.
abstract: OBJECTIVE
  Surgery to the internal nasal valve is presently approached either externally via an open rhinoplasty incision or transnasally. The endoscopic approach has become the preferred method of access to various other sinonasal conditions. The goal of this study was to evaluate 1) whether the internal nasal valve could be accessed and evaluated endoscopically and 2) whether a spreader graft placed under endoscopic visualization could widen the nasal valve area.
  
  
  METHODS
  Single-blinded study on 8 cadaveric heads. One side per head was randomly selected to be studied. The contralateral side served as the control. The nasal valve was approached endoscopically via the submucoperichondrial plane of the nasal septum with a 30-degree endoscope. After fully examining and subsequently separating the internal nasal valve, a spreader graft was placed. A blinded examiner then performed acoustic rhinometry to measure the nasal valve area as well as corroborate the position from an external approach. This data was then statistically analyzed using the paired Student t test.
  
  
  RESULTS
  The nasal valve was easily detected endoscopically and the position of the spreader grafts was externally confirmed in all 8 specimens. The mean change of the nasal valve area on the side with the spreader grafts was 0.28 cm2. On the control side, the mean change was 0.026 cm2. This difference was statistically significant (P = 0.004).
  
  
  CONCLUSIONS
  The endoscopic approach is a viable option in accessing the nasal valve. Endoscopic placement of a spreader graft has also been shown to statistically widen the nasal valve area.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, Joan and Sanford Weill Medical College of Cornell University, New York, New York 10021, USA. clarkhuangmd@yahoo.com
authors.forename: Clark
authors.initials: C
authors.lastname: Huang
authors.forename: Casey R A
authors.initials: CR
authors.lastname: Manarey
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
mesh_terms: D002102:Cadaver; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000601:surgery*; D015508:Nasal Obstruction / Q000601:surgery*; D009300:Nasal Septum / Q000637:transplantation*; D023842:Rhinometry, Acoustic; D012225:Rhinoplasty; D016037:Single-Blind Method; D019737:Transplants