Impact of Upper Lateral Cartilage Preservation in Open Preservation Rhinoplasty on Internal Nasal Valve Function


  • Chenar Yasin Aziz Kalar general hospital
  • Ari Rahim Zangana University of Sulaimni College of Medicine
  • Hemin Othman Sharif University of Sulaimni College of Medicine


Internal nasal valve, Functional outcomes, Nasal wall function, Open preservation, Rhinoplasty, Upper lateral cartilage


Background and Objectives: Open preservation rhinoplasty is a surgical technique that aims to
enhance both the aesthetic and functional aspects of the nose. Preservation of the upper lateral
cartilages plays a crucial role in maintaining the structural integrity and function of the internal nasal
valve. This study aimed to evaluate the impact of preserving the upper lateral cartilages on internal
nasal valve function in open preservation rhinoplasty procedures, specifically focusing on the internal
nasal valve .
Methods: A non-randomized clinical trial between April 2022 and January 2023 was conducted in the
Sulaimani region of Kurdistan, Iraq, involving 36 adult patients undergoing OPR. Data collection
included preoperative and postoperative assessments using the NOSE questionnaire, along with
physical examinations at 9 days, 3 months, and 6 months post-surgery, and photographs 3 months post
Results: The results showed significant improvements in functional outcomes, including nasal
stuffiness or congestion, nasal obstruction, breathing problems through the nose, sleeping problems,
and breathing problems during exercise. These improvements were statistically significant (p=0.001).
Based on the Rhinoplasty Outcome Evaluation (ROE), significant differences were observed in nasal
shape, nasal breathing, friends' and acquaintances' approval of the surgery, unrestricted social activities,
the aesthetic and structural appearance of the nose, and the reasons for seeking nasal shape alteration
or rhinoplasty.
Conclusion: Preservation of ULCs in OPR procedures positively impacts internal nasal valve function,
as demonstrated by improved postoperative outcomes. This technique maintains nasal structure
integrity and INV function, leading to favorable functional and aesthetic results.


Fichman M, Piedra Buena IT. Rhinoplasty. StatPearls. Treasure Island (FL) ineligible

companies. Disclosure: Ignacio Piedra Buena declares no relevant financial relationships with

ineligible companies.: StatPearls Publishing, Copyright © 2024, StatPearls Publishing LLC.; 2024.

Kosins AM. Preservation Rhinoplasty: Open or Closed? Aesthetic Surgery Journal.


Anco N, Caballero G, Adrianzen G. Preservation Rhinoplasty: A New Approach to Mestizo

Noses. Plastic and reconstructive surgery Global open. 2023;11(5):e4972.

Ng CL, D'Souza A. 120 Years of Dorsal Preservation in Rhinoplasty. Facial Plastic Surgery.


Haddad A, Dodin G, Hossu G, Perez M, Teixeira P, Rumeau C, et al. Anatomy of the nasal

latero-lateral cartilage articulation: a micro-MRI study in human specimens. Surgical and

radiologic anatomy : SRA. 2022;44(10):1367-74.

Sakarya EU, Kar M, Bafaqeeh SA. Surgical Anatomy of the External and Internal Nose.

In: Cingi C, Bayar Muluk N, editors. All Around the Nose: Basic Science, Diseases and Surgical

Management. Cham: Springer International Publishing; 2020. p. 39-47.

Shafik AG, Alkady HA, Tawfik GM, Mohamed AM, Rabie TM, Huy NT. Computed

tomography evaluation of internal nasal valve angle and area and its correlation with NOSE scale

for symptomatic improvement in rhinoplasty. Brazilian journal of otorhinolaryngology.


Patel PN, Most SP. Open Preservation Rhinoplasty. Facial plastic surgery : FPS.


Goksel A, Tran KN. Open Preservation Rhinoplasty Using the Piezo Electric Instrument.

Facial plastic surgery clinics of North America. 2023;31(1):59-71.

Bafaqeeh SA, Bayar Muluk N, Cingi C. Are preservation rhinoplasty techniques safer than

structural ones? European review for medical and pharmacological sciences. 2023;27(5):11-8.

Sozansky Lujan J, Goldfarb JM, Barrera JE. Functional and Aesthetic Outcomes of Let

Down Dorsal Preservation Rhinoplasty. Facial plastic surgery & aesthetic medicine.


Merino-Galvez E, Gómez-Hervás J. Evaluation of Nasal Obstruction Following

Septoturbinoplasty Using the VAS and NOSE Scale. Iranian journal of otorhinolaryngology.


Merma-Linares C, Martinez MD, Gonzalez M, Alobid I, Figuerola E, Mullol J.

Management of Mechanical Nasal Obstruction Isolated or Associated to Upper Airway

Inflammatory Diseases in Real Life: Use of both Subjective and Objective Criteria. Current allergy

and asthma reports. 2023;23(10):567-78.

Peterson AM, Kallogjeri D, Spitznagel E, Chakinala MM, Schneider JS, Piccirillo JF.

Development and Validation of the Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic

Telangiectasia (NOSE HHT). JAMA otolaryngology-- head & neck surgery. 2020;146(11):999-

Portillo-Vásquez AM, Jiménez-Chobillón MA, Santillán-Macías A, Cristerna-Sánchez L,

Castorena-Maldonado AR. Validation of the Nasal Obstruction Symptom Evaluation Scale in

Mexican Adults. Archives of Medical Research. 2022;53(3):329-35.

Carmel Neiderma NN, Halevy N, Kas T, Wengier A, Safadi A, Abergel A. Adaptation and

Validation of the Hebrew Version of the Nasal Obstruction Symptom Evaluation (NOSE) Scale.

The Israel Medical Association journal : IMAJ. 2023;25(8):564-7.

Spiekermann C, Savvas E, Rudack C, Stenner M. Adaption and validation of the nasal

obstruction symptom evaluation scale in German language (D-NOSE). Health and quality of life

outcomes. 2018;16(1):172.

Karahatay S, Taşlı H, Karakoç Ö, Aydın Ü, Türker T. Reliability and validity of the Turkish

Nose Obstruction Symptom Evaluation (NOSE) scale. Turkish journal of medical sciences.


Elwany S, Atef A, Ismail AS, Hussein WKA, Ibrahim AA, Abdelnaby M, et al. Arabic

translation and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. The

Egyptian Journal of Otolaryngology. 2021;37(1):92.

Kim TK, Jeong JY. Surgical anatomy for Asian rhinoplasty: Part II. Arch Craniofac Surg.


Stergiou G, Tremp M, Finocchi V, Saban Y. Functional and Radiological Assessment After

Preservation Rhinoplasty - A Clinical Study. In Vivo. 2020;34(5):2659-65.

Brown WE, Lavernia L, Bielajew BJ, Hu JC, Athanasiou KA. Human nasal cartilage:

Functional properties and structure-function relationships for the development of tissue

engineering design criteria. Acta Biomaterialia. 2023;168:113-24.

Yoon SH, Kim CS, Oh JW, Lee KC. Optimal harvest and efficient use of septal cartilage

in rhinoplasty. Arch Craniofac Surg. 2021;22(1):11-6.

Park DH, Lee CA, Jeong CY, Yang HS. Nasotracheal intubation for airway management

during anesthesia. Anesth Pain Med (Seoul). 2021;16(3):232-47.

Ashrafi AT. Management of Upper Lateral Cartilages (ULCs) in Rhinoplasty. World J Plast

Surg. 2014;3(2):129-37.

Paul MA, Kamali P, Chen AD, Ibrahim AMS, Wu W, Becherer BE, et al. Assessment of

Functional Rhinoplasty with Spreader Grafting Using Acoustic Rhinomanometry and Validated

Outcome Measurements. Plastic and Reconstructive Surgery – Global Open. 2018;6(3):e1615.

Kandathil CK, Saltychev M, Patel PN, Most SP. Natural History of the Standardized

Cosmesis and Health Nasal Outcomes Survey After Rhinoplasty. The Laryngoscope.


de Souza OE, Lavinsky-Wolff M, Migliavacca RO, de Azeredo AM, Colognese Gabbardo

AV, Velho JS. Analysis of Determinants of Postoperative Satisfaction After Rhinoplasty.

Laryngoscope. 2022;132(8):1569-75.

Zojaji R, Ataei M, Zojaji SH, Meshkat M. The effect of nasal skin thickness on the outcome

of rhinoplasty. European Journal of Plastic Surgery. 2024;47(1):6.