Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Comparative Efficacy of Suture-Based Techniques for Internal Nasal Valve Reconstruction: A Systematic Review

Document Type : Systematic Review

Authors
Raden Ayu Anatriera Sumarsono 1
Mikhael Yosia 1
Rejoel Mangasa Siagian 2
1 Department of Otorhinolaryngology-Head & Neck Surgery, Universitas Indonesia, Jakarta, Indonesia, 10430.
2 Medical Technology IMERI, Faculty of Medicine Universitas Indonesia, 10430.
10.22038/ijorl.2026.96557.4179
Abstract
Objective
The internal nasal valve (INV) is the principal site of nasal airflow resistance. Cartilage grafting is the established correction; suture-based techniques are a conservative alternative with poorly defined comparative efficacy. We synthesised symptomatic, anatomic and durability outcomes of suture-based INV reconstruction in adults, stratified by intervention class.
Data Sources:
PubMed, Science Direct and the Cochrane Library were searched from inception to May 2026. Grey literature was retrieved through ProQuest (dissertations, theses, conference proceedings) and CENTRAL trial registrations, and reference lists were hand-screened.
Methods of Review:
The review was conducted following PRISMA 2020, Eligible studies enrolled ≥8 adults undergoing isolated or predominantly suture-based INV reconstruction. The risk of bias for each study was assessed using the Joanna Briggs Institute checklists and the Cochrane RoB 2.
Results:
Twelve studies (n = 471) were included. Across studies reporting paired NOSE data, preoperative scores of 65–75 fell to 11–28 (absolute reduction 45–64 points, 62–85%; all p<0.05), exceeding the 15–30-point minimal clinically important difference. Anatomic gains were concordant: minimal cross-sectional area +73–78%, INV angle +43–80%, peak inspiratory flow +59%.
Conclusions:
Suture-based INV reconstruction produced large, consistent symptomatic improvement with concordant anatomic gains across all three classes. These data support a phenotype-based choice that was tested prospectively.
Keywords
Internal nasal valve
Nasal valve collapse
Nasal obstruction
Suture suspension
Functional rhinoplasty
Nasal obstruction symptom evaluation (NOSE)
Subjects
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Iranian Journal of Otorhinolaryngology
Volume 38, Issue 6
November and December 2026
Pages 353-367