Alar Battens Grafts Versus Lateral Crural Strut Grafts: A Systematic Review of Postoperative Outcomes.

Abstract

To systematically compare functional outcomes and postoperative cosmetic satisfaction following alar batten graft (ABG) versus lateral crural strut graft (LCSG) placement for patients with nasal valve incompetence. Pubmed and Embase searches (1995-2025) with terms for nasal obstruction, LCSG, ABG, and functional/cosmetic outcomes. Relevant studies with documented preoperative nasal valve incompetence, confirmed surgical intervention with either ABG or LCSG, and their associated postoperative outcomes were identified. Review methods adhered to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Due to heterogeneous study designs and incomplete variance data, the findings are presented as ranges without a quantitative meta-analysis. Fifteen studies (n = 1052 patients; LCSG = 690, ABG = 362) were included. Among eight LCSG studies, mean nasal obstruction symptom evaluation (NOSE) score improvements ranged from 15.8 to 65.6 points, and visual analog scale (VAS)-function improvements ranged from 10.1 to 44.3 points. Seven ABG studies demonstrated NOSE improvements of 25.6 to 69.0 points, and VAS-function improvements ranged from 24.0 to 54.5 points. Validated cosmetic patient-reported outcome measures (Standardized Cosmesis and Health Nasal Outcomes Survey [SCHNOS]-C, VAS-cosmesis, and Facial Aesthetic Clinical Evaluation-Questionnaire [FACE-Q]) were used in LCSG cohorts, showing consistent esthetic gains. No ABG studies employed a standardized cosmetic measure. Heterogeneity precluded pooled analysis. Both ABG and LCSG yield substantial functional improvements for nasal valve incompetence across numerous studies. Cosmetic satisfaction appears favorable for LCSG but is undercharacterized for ABG due to a lack of reported standardized patient outcome measures. Large, prospective, and multi-institutional studies investigating outcome differences are needed, given the significant heterogeneity across study methods in the existing literature.