Clin Exp Otorhinolaryngol.  2024 Aug;17(3):189-197. 10.21053/ceo.2024.00073.

Management of Nasal Valve Dysfunction

• Lee DY
• Won TB

• KMID: 2558835
• DOI: http://doi.org/10.21053/ceo.2024.00073

Abstract

Nasal valve dysfunction can substantially impact nasal airflow and overall quality of life. This review provides a comprehensive examination of nasal valve dysfunction, including its mechanisms, classification, and surgical management. The nasal valves include internal and external valves, each of which plays a crucial role in regulating nasal airflow. Subclassification of the external nasal valve into alar and rim valves helps specify the site of obstruction when present and informs the choice of surgical intervention. Dynamic nasal valve obstruction, often characterized by inspiratory collapse of the nasal valve, must be distinguished from static obstruction, which refers to nasal valve stenosis. Accurate identification of the location and mechanism of nasal valve dysfunction is essential for effective management. Various surgical procedures target specific components of the nasal valve and can produce favorable functional outcomes. The selection of surgical procedures, whether individually or in combination, should be tailored to the characteristics of nasal valve dysfunction and the external nasal characteristics of the patient. Strict adherence to proper surgical techniques is imperative for achieving optimal treatment outcomes.

Keyword

Rhinoplasty; Nasal Obstruction; Nasal Valve; Dysfunction; Surgical Procedure

Figure

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  Fig. 1. Dynamic and static obstruction of the external nasal valve. (A, B) Dynamic obstruction during inhalation. (C) Static obstruction of the left nasal valve.

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  Fig. 2. Diagnostic maneuvers for nasal valve dysfunction. (A) Cottle maneuver. (B) Modified Cottle test.

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  Fig. 3. Anatomical landmarks of the internal nasal valve. (A) Illustration of the right internal nasal valve. (B) Endoscopic view of the right internal nasal valve. (C) Endoscopic view of the denuded internal nasal valve following mucosa removal. UL, upper lateral; T, inferior turbinate; S, septum; ULC, upper lateral cartilage.

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  Fig. 4. Schematic diagrams of the nasal valve. 1, internal nasal valve; 2, alar valve; 3, rim valve.

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  Fig. 5. Recurvature of the alar cartilage. The recurvature in the alar cartilage may induce static obstruction in the nasal valve impeding airflow. (A) Frontal view. (B) Basal view.

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  Fig. 6. Spreader graft. A cartilage graft is inserted into a pocket between the upper lateral cartilage and the dorsal septum to restore the internal nasal valve. (A) Before and (B) after insertion of bilateral spreader grafts.

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  Fig. 7. Flaring suture with an onlay graft. Horizontal mattress sutures are applied to both upper lateral cartilages over an onlay graft positioned above the dorsum.

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  Fig. 8. Butterfly graft. A cartilage graft is positioned at the junction of the upper and lower lateral cartilages, improving the function of both the internal nasal valve and the alar valve. (A) Before and (B) after placement of the butterfly graft.

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  Fig. 9. Design of the alar batten graft. A cartilage graft is positioned non-anatomically, primarily on the lateral wall soft tissue.

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  Fig. 10. Lateral crural flip-flop. (A) Deformed lateral crura. (B) Excision of the deformed segment of cartilage. (C) Flipping of the excised cartilage. (D) Suturing of the excised cartilage to the lower lateral cartilage.

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  Fig. 11. Lateral crural strut graft. (A) Curled lateral crura. (B) Creation of a pocket between the vestibular mucosa and the lateral crura. (C) Insertion of the cartilage graft.

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  Fig. 12. Columelloplasty. (A) Wide columellar base. (B) Medial footplate and soft tissue resection. (C) After columelloplasty.

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  Fig. 13. Alar rim graft. (A) Creation of subcutaneous pockets on the inner aspect of the alar cartilage. (B) Insertion of the cartilage graft. (C) Suture placement following alar rim graft.

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  Fig. 14. Alar rim vestibuloplasty. (A) Left rim valve stenosis. (B) Scar lysis. (C) Cartilage graft for rim support. (D) Harvesting of a skin graft from the retroauricular area. (E) After skin grafting. (F) Silastic sheet bolstering. (G) After alar rim vestibuloplasty.

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