European Journal of Plastic Surgery

, Volume 35, Issue 7, pp 501–506 | Cite as

Triple-procedure technique in internal nasal valve surgery

  • Shahram AnariEmail author
  • Mohamed R. El Badawey
Original Paper


In cases of narrowing of the internal nasal valve angle, we address all structures that commonly contribute to the internal valve area obstruction. We term this the “triple-procedure technique”. The aim of this study was to assess the efficacy of this technique in improving patients' subjective nasal patency. A prospective longitudinal case study was conducted in a tertiary hospital in northeast of England. All consecutive patients who complained of nasal obstruction and were diagnosed with the internal nasal valve angle narrowing due to septal deviation were offered to have a triple-procedure operation (septoplasty, turbinate surgery and internal nasal valve surgery). Patients completed a validated nose-related questionnaire (Nasal Obstruction Symptom Evaluation (NOSE)) preoperatively, which was repeated 3 months after the operation. The change in NOSE score was the outcome measure. Eight of the nine patients recruited to the study completed the questionnaires (88% response rate). The total and the domain scores improved after the operation, which were clinically and statistically significant. The effect size proved to be very large (total NOSE score effect size, 4.0). Our study shows that addressing all three structures commonly affecting the internal valve area is an effective technique in improving the obstruction caused by the narrow internal nasal valve angle.


Nasal valve surgery Rhinoplasty Nasal airway M-Plasty Nasal obstruction Internal nasal valve 


Conflicts of interest

The authors are not aware of any conflicts of interest and have not received any financial help in conducting this study.

Supplementary material

Video clip

This video clip demonstrates the surgical steps in M-plasty (WMV 5765 kb)


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of Otolaryngology/Head and Neck Surgery, ENT DepartmentHeartlands HospitalBirminghamUK
  2. 2.Department of Otolaryngology/Head and Neck SurgeryFreeman HospitalNewcastle upon TyneUK

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