Nasal Airflow Changes With Bioabsorbable Implant, Butterfly, and Spreader Grafts

• Published in: The Laryngoscope 2020-12, Vol.130 (12), p.E817-E823
• Main Authors: Brandon, Bryan M., Stepp, Wesley H., Basu, Saikat, Kimbell, Julia S., Senior, Brent A., Shockley, William W., Madison Clark, J.
• Format: Article
• Language: English
• Subjects: Absorbable Implants; Airway Resistance; bioabsorbable nasal implant; butterfly graft; Cadaver; Ear Cartilage - transplantation; Humans; Hydrodynamics; internal nasal valve repair; Nasal Cartilages - surgery; Nasal Obstruction - surgery; Nasal valve collapse; Nose; Patient-Specific Modeling; Reconstructive surgery; Rhinoplasty - methods; Skin & tissue grafts; spreader graft; Suture Techniques; Tomography, X-Ray Computed
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.28691

Objectives/Hypothesis Internal nasal valve compromise is a major cause of nasal obstruction, with a growing number of ways to treat this condition. In this study, we compared the effects of butterfly graft, spreader graft, and the bioabsorbable nasal implant on nasal airflow resistance. Study Design Cadaver study. Methods Computational fluid dynamics (CFD) simulations were completed from nine preoperative and postoperative cadaveric subjects. Each cadaveric head underwent placement of a bioabsorbable nasal implant (BNI) (Spirox Latera; Stryker ENT, Plymouth, MN), butterfly graft, or spreader graft. Pre‐ and postoperative computed tomography (CT) scans were used to generate three‐dimensional models of the nasal airway used in steady‐state CFD simulations of airflow and heat transfer during inspiration. Results Butterfly graft placement resulted in a mean improvement in nasal airway resistance of 24.9% (±7.3), whereas BNI placement resulted in a 6.7% (±1.2) improvement, and spreader graft placement also resulted in a consistent improvement of 2.6% (±13.5). Pressure within the main nasal cavity was consistently lower following butterfly graft placement versus a spreader graft or BNI. Butterfly and spreader graft placement also resulted in modest improvements in airflow allocation, whereas BNI demonstrated more variation (−1% to 12%). Heat flux was not significantly different; however, a small improvement in total heat flux was seen with all three interventions. Conclusions The results of this study demonstrate reduction in nasal airway resistance in all three surgical interventions, with the butterfly graft demonstrating superiority to the other two techniques. However, these data only reflect a static environment and not dynamic changes in airflow seen during respiration. Level of Evidence NA Laryngoscope, 130:E817–E823, 2020