A systematic review of the surgical techniques for the treatment of internal nasal valve collapse: where do we stand?
BACKGROUND
A myriad of interventions have been described to address the restoration or preservation of the internal nasal valve, the narrowest portion of nasal airway.


OBJECTIVE
To review systematically available knowledge and evidence about management options of the collapse of the internal nasal valve area.


METHODS
Systematic review.


METHODS
A MEDLINE, EMBASE, Cochrane Library and CENTRAL database search, followed by extensive hand searching for the identification of relevant studies.


METHODS
Review of all English-language studies addressing the treatment of the internal nasal valve collapse.


RESULTS
Fifty-three studies were eventually identified and systematically reviewed. The majority (50 of 53) of the included articles are graded as level IV evidence and only one randomised trial was identified. The included randomised study reported no significant difference in improvement between the intervention group (autospreader flap) and placebo arms. The majority of the included studies presented in this systematic review provide level IV evidence concerning the optimal approach for cases of nasal valve collapse. Current research is driven more by reports of techniques than patient outcomes.


CONCLUSIONS
Proper evaluation and identification of the cause of the internal nasal valve collapse is paramount prior to selection of the preferred surgical solution. The three-dimensional construction of the nasal valve implies that many pathologies cannot be restored by a single solution. Treatment approaches should be directed at specific involved sites. Present systematic review of the literature revealed that the available evidence is based on low-level studies and focuses more on the description of various surgical techniques rather than on patient-reported outcome measures. Future studies are needed, including homogenous patient groups, comparing different surgical techniques and incorporating patient-reported outcome measures.
Imperial College NHS Trust, St Mary's Hospital, London, UK.
J K
JK
Goudakos
Imperial College NHS Trust, St Mary's Hospital, London, UK.
J M
JM
Fishman
Imperial College NHS Trust, St Mary's Hospital, London, UK.
K
K
Patel
D006801:Humans; D055171:Nasal Cartilages / Q000473:pathology*; D015508:Nasal Obstruction / Q000209:etiology* / Q000601:surgery*; D009300:Nasal Septum / Q000473:pathology*; D012225:Rhinoplasty / Q000379:methods*