Modified Dermal-Fat Flap Suspension Technique for Internal Nasal Valve Dysfunction: A Comparative Study With Conventional Cartilage Grafting.

Abstract

Iatrogenic internal nasal valve (INV) dysfunction is a significant complication after nasal surgery, often necessitating revision surgeries involving cartilage grafting, which carries high risks of complications such as mucosal synechiae, septal perforations, and chronic inflammation. This study evaluates the efficacy of a modified dermal-fat flap suspension technique as an alternative to conventional cartilage grafting for INV reconstruction. A retrospective review was conducted of 30 patients treated between March 2019 and March 2023, including 8 patients who underwent the modified dermal suspension technique and 22 who received spreader grafts. Preoperative and postoperative nasal obstruction symptom evaluation scores were statistically analyzed using the Mann-Whitney U test. While both groups demonstrated significant postoperative improvements, no statistically significant differences were found between the groups. The modified technique, performed under local anesthesia, was associated with fewer complications and avoided extensive cartilage grafting or mucosal dissection, making it particularly suitable for patients with advanced age, high ASA scores, or complex surgical histories. Common complications included transient orbital edema and rare cases of skin discoloration, which resolved over time. Despite a small sample size and reliance on subjective nasal obstruction symptom evaluation scores, this study highlights the potential of the modified dermal-fat flap suspension technique as a less invasive, effective alternative for managing INV dysfunction, especially in high-risk patients. Further studies with larger cohorts and objective measures are needed to validate these findings.