title: Alar Suspension Sutures in the Management of Nasal Valve Collapse.
abstract: OBJECTIVE
  This study assesses the efficacy of alar suspension sutures in the management of nasal valve collapse causing nasal obstruction. These sutures are inserted between the vestibular skin and lateral crura and hitched to the periosteum of the medial inferior orbital margin; this is a variation of the alar (change everywhere) suspension suture technique.
  
  
  METHODS
  A retrospective review of patients who underwent alar suspension suture insertion between January 2009 and December 2010 in the management of nasal obstruction was undertaken. Symptoms of nasal obstruction were assessed using the Visual Analogue Scale (VAS) and peak inspiratory flow rate (PIFR). This was measured preprocedure and repeated at 3, 6, and 12 months postoperatively.
  
  
  RESULTS
  A total of 35 patients were identified, and 26 were included in the study; 90% of patients were satisfied with the outcome of surgery, supported by improvement in the VAS and PIFR scores. The mean difference in VAS preprocedure and postprocedure was 4.97 (P value = 0.00), and the average improvement in PIFR was 25.5 L/min (P value = 0.00).
  
  
  CONCLUSIONS
  Our study shows a significant improvement in patient's symptoms following insertion of alar suspension sutures. It is, therefore, a reliable, safe, and effective technique in treating nasal obstruction secondary to nasal valve collapse.
authors.affiliation: Doncaster Royal Infirmary, Doncaster, UK.
authors.forename: Jaiganesh
authors.initials: J
authors.lastname: Manickavasagam
authors.affiliation: Northern Deanery, Newcastle upon Tyne, UK ismaiqbal@doctors.net.uk.
authors.forename: Isma
authors.initials: I
authors.lastname: Iqbal
authors.affiliation: Doncaster Royal Infirmary, Doncaster, UK.
authors.forename: Smeeta
authors.initials: S
authors.lastname: Wong
authors.affiliation: Doncaster Royal Infirmary, Doncaster, UK.
authors.forename: Ullas
authors.initials: U
authors.lastname: Raghavan
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D009666:Nose / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D057240:Patient Preference; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D011184:Postoperative Period; D012129:Respiratory Function Tests / Q000379:methods; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000009:adverse effects / Q000379:methods; D013518:Surgery, Plastic / Q000379:methods; D013536:Suture Techniques / Q000009:adverse effects*; D016896:Treatment Outcome; D064232:Visual Analog Scale
keywords: facial plastics; measuring clinical outcomes in facial plastic surgery; nasal obstruction; nasal surgery; rhinoplasty