24-Month Case Study
Two-year sustained benefit of an absorbable implant for the
treatment of NVC.
The patient was a 53-year-old man with a 3-year history of NAO. Examination using the modified Cottle maneuver revealed NVC was a contributor to the patient’s symptoms. The patient completed the Nasal Obstruction Symptom Evaluation (NOSE) instrument at baseline and at subsequent follow-up visits. The patient had a baseline NOSE score of 65, indicative of severe NAO symptoms.15 Surgical correction consisting of functional rhinoplasty using cartilaginous grafts, suturing techniques, or an absorbable implant was offered.
The target location of the implant was identified to provide maximum support to the upper and lower lateral cartilages at the area of maximal collapse. A skin hook was used to evert the alar rim, and the delivery device cannula was used to pierce the vestibular skin in the area of a conventional marginal incision. The cannula was advanced toward the vestibular lining and the caudal edge of the lower lateral cartilage. The implant was fully deployed in the target location.
- Follow-up visits occurred at 1 week and 1, 3, 6, 12, 18, and 24 months post-procedure. Throughout the 2-year follow-up period, no adverse events were reported, and the patient did not require intranasal steroids, external nasal device usage, surgeries or other treatments.
- The NOSE score improved from a preoperative classification of severe to post-operative classification of mild for all follow-up time points (week 1 = 25, month 1 = 25, month 3 = 15, month 6 = 5, month 12 = 5, month 18 = 20, and month 24 = 25).
- Although the NOSE scores fluctuated across the follow-up time points (5 to 25), all of the scores were indicative of mild symptoms.
- Cosmetic changes were assessed using four photographic views obtained under both static and full inhalation (frontal view, left side, right side, and chin up). An independent physician reviewer assessed cosmetic changes by comparing baseline images to follow-up images. This evaluation confirmed the absence of cosmetic changes from baseline to all follow-up time points.
The patient in this case study achieved lasting benefits through 24 months with average NOSE score improvement of 48 points. Future studies will need to confirm the benefit of this new technology, including objective assessments of NVC.
San Nicoló M, Berghaus A. Two-year sustained benefit of an absorbable implant for the treatment of NVC. Sage. First published August 2, 2017. DOI: 10.1177/2473974X17722982