Background: Several sinonasal procedures can now be accessed more easily through the endoscopic approach. In addition to magnification, the endoscope may light up sections that are otherwise hard to reach. This research aimed to identify if the endoscopic approach is a viable method for accessing the internal nasal valve for the surgical manipulation and to document if H-shaped graft placed endoscopically widens the nasal valve area.

Patients and methods: We carried out this prospective study performed on four female patients who had intractable internal nasal valve dysfunction recruited from the ENT outpatient clinic in Zagazig university hospital. Every patient underwent: Anterior rhinoscopy and nasal flexible fiberoptic nasopharyngeal endoscope. Within two weeks prior to surgery and again at 6 months postoperatively, all patients finished the Rhinoplasty Outcomes Evaluation (ROE) and the Nasal Obstruction Symptom Evaluation (NOSE).

Results: As regard nasal congestion and stuffiness: pre-operative all patients 12(100%) complained from severe nasal congestion and stuffiness, whereas post-operative complete relieved of symptom in 9 out 12patients (75%) and 3 patient had mild nasal congestion and stuffiness, with statistically significant difference (p<0.05). The mean ± SD of ROE Function improved from (59.4±6.3) (range 50–62.5) preoperatively to (100±0) (range100–100) postoperatively, with statistically significant difference (p< 0.05).

Conclusion: The endoscopic-assisted internal nasal valve reconstruction using H-shaped cartilage graft technique presents a promising solution for patients suffering from nasal valve insufficiency. By combining the spreader and splay effects, the H-shaped graft increases graft stability on the dorsal septum.