The Latera, an absorbable nasal implant, is a minimally invasive, alternative treatment for nasal valve collapse. The LATERA is used to support the upper and lower cartilage inside the lateral (side) wall of your nose reducing nasal airway obstruction symptoms and helping you breathe better. The implant, which is FDA approved for the treatment of nasal obstruction, is placed trans-cutaneously over the nasal valve area to support and stent open the lateral nasal wall and provide for an unimpeded nasal airway. The stent lasts for approximately 18 months during which time scar tissue is created to keep the valve area open after the implant absorbs and dissolves.
The nose processes the air that you breathe before it enters your lungs–it warms, humidifies and purifies the air to protect your health. Your nose is also where more than half of your airflow resistance occurs when you breathe. Airflow resistance is important for good pulmonary function. The anterior portion of the nose, including the internal and external nasal valves, is where most of the resistance occurs, but it is the internal nasal valve where most of the flow resistance is created.
The external nasal valve is the nostril margin where air meets the nose and its position relative to the septum. The internal nasal valve is the narrowest point of the nasal passage. It is located further in the nose with the boundaries consisting of the lateral nasal sidewall or cauda (bottom) end of the upper lateral cartilage, the nasal septum, and the head of the inferior turbinate, making a triangle-shaped space. When patients have problems with nasal airflow, it is usually because the internal nasal valve has become more narrow restricting air from passing freely into the nose. This narrowing may occur, with a deviated nasal septum, when the turbinate swells, or the nasal sidewall collapses during inspiration. Consequently, this nasal valve collapse makes it difficult for patients to breathe through their nose (nasal obstruction), causing nasal congestion and blockage.
Generally, nasal valve surgery is recommended for these patients to help restore the normal anatomy of the nasal valve and improve airflow. But now the Latera Implant is being offered as an alternative to nasal valve surgery.
The most common symptoms for nasal airway obstruction include:
- Nasal congestion or stuffiness
- Nasal blockage or obstruction
- Trouble breathing through your nose
- Trouble sleeping
- Inability to get enough air through your nose during exercise or exertion
A nasal obstruction, in general, can have many causes. For some patients, allergies lead to swelling of the nasal and sinus lining, which causes congestion and blockage. For other patients, the blockage may be due to a simple anatomical obstruction, such as enlarged adenoids, a polyp in the nasal passage, a deviated septum, enlarged turbinates or narrow nasal passages. Often patients with narrow nasal passages have problems with the nasal septum and turbinates.
If septal and/or turbinate surgery alone doesn’t correct nasal obstructive impairment, then nasal valve collapse surgery should be considered.
During a consultation, your ENT (ear, nose, and throat) doctor will ask you to inhale through your nose to see if the nasal sidewall moves inward and collapses leading to blockage of nasal airflow. At this time, your doctor will also do a visual exam of your nasal cavity using a 4mm, lighted endoscope, evaluating the condition of your nasal valves as well as all adjacent structures. This is done to rule out all possible causes of your nasal obstruction (e.g., deviated septum, enlarged turbinates, sinus masses, polyps, and enlarged adenoids) for proper diagnosis and treatment recommendation.
Another test your doctor may perform is the Cottle test, which is done to evaluate nasal valve collapse. With this test, the cheek of the evaluated side is gently pulled laterally with 1 or 2 fingers as you inhale, which opens the valve. If your breathing is better when this is done, then it implies that a collapse of the valve is present on that side. If breathing is not better, then that means there is another cause of the obstruction elsewhere in the nose.
Patients who have weak or thin cartilage in the nasal valve area have inadequate support and are at higher risk for nasal valve collapse. This weakness may be due to a patient’s particular anatomy or may be secondary to a patient’s previous surgery (e.g., rhinoplasty), trauma or injury to the nose. For these patients, the Latera Implant would be beneficial in helping to restore normal nasal airflow and breathing.