Surgical access to the internal nasal valve.

OBJECTIVES To measure the width of the nasal septum in the region of the internal nasal valve using radiographic images to support use of open septorhinoplasty for alteration of the internal nasal valve and to compare short-term patient satisfaction for open septorhinoplasty vs endonasal septoplasty. STUDY DESIGN Radiographic study and chart review. METHODS The width of the nasal septum at the level of the inferior turbinates and at the level of maximum septal thickness was measured on computed tomographic scans of 70 patients. Patient satisfaction 12 weeks after treatment was assessed in 113 patients who underwent septoplasty or open septorhinoplasty for nasal obstruction and septal and internal nasal valve abnormalities. RESULTS Measures from the computed tomographic scans revealed that the nasal septum was significantly wider at the internal nasal valve than at the inferior aspect of the septum. All 34 patients who underwent septoplasty and all 79 patients who underwent open septorhinoplasty were satisfied with the results at 12 weeks after surgery. CONCLUSIONS Anatomic evidence supports the need to address the superior septum. Although this may be facilitated by an open septorhinoplasty approach, short-term results showed no difference in patient satisfaction with this technique compared with septoplasty. The differences between the techniques may be evident on long-term follow-up.