The Effects of Lateral Crural Tensioning with an Articulated Alar Rim Graft Versus Lateral Crural Strut Graft on Nasal Function.

Nasal valve dysfunction can be addressed by various valve reinforcement techniques. There is no consensus on which technique is most efficacious. To evaluate lateral crural tensioning with articulated alar rim grafting (LCT/AARG) versus the lateral crural strut graft (LCSG) for their efficacy as nasal valve reinforcement techniques in rhinoplasty. A cohort study was undertaken on patients who underwent either the LCT/AARG or LCSG as part of their rhinoplasty procedure. Airway testing was performed preoperatively and 6 months after the procedure, with data collected from February 2015 to July 2018 at a single tertiary rhinologic practice. Consecutive adults underwent open structure septorhinoplasty by one surgeon for both cosmetic and functional indications, as both primary and revision cases. The primary functional outcomes analyzed were the nasal peak inspiratory flow (NPIF) and total nasal airway resistance (NAR). The primary patient-reported outcome measures analyzed were the visual analogue scale (VAS) for nasal obstruction, the Nasal Obstruction Symptom Evaluation (NOSE), and nasal obstruction score. Data were also normalized as a percentage improvement over preoperative baseline, to account for individual variability. In total 94 participants were recruited (33.7 ± 11.7 years, 85.3% female) with 26.6% in the LCT/AARG group and 73.4% in the LCSG group. Change in NAR (ΔNAR) was significantly better in the AARG group (-18.73 ± 26.84 Pa/cc vs. 15.07 ± 55.57 Pa/cc,  < 0.001). In addition, NAR improved significantly when analysis was isolated to the LCT/AARG group (0.414 ± 0.255 Pa/(cc·s) vs. 0.291 ± 0.116 Pa/(cc·s), Δ = -0.122 Pa/(cc·s),  = 0.004) despite change in NAR being insignificant for the entire study population after surgery (0.370 ± 0.177 Pa/(cc·s) vs. 0.349 ± 0.152 Pa/(cc·s), Δ = 0.021,  = 0.320). There were no significant differences between the study groups in ΔNPIF (15.85 ± 31.48 L/min vs. 8.20 ± 30.12 L/min,  = 0.285), ΔVAS (35.77 ± 130.52 vs. 31.38 ± 73.19,  = 0.838), ΔNOSE (-73.60 ± 25.43 vs. -27.31 ± 123.44,  = 0.085), and Δnasal obstruction (64% experiencing improvement vs. 63.2% experiencing improvement,  = 0.097). LCT/AARG demonstrated benefit in total NAR over the LCSG. There were no other significant functional differences between the two techniques.