Surgery for Nasal Valve Compromise

Chang, Jinsoon

Abstract

The nasal valve spans a minimal cross sectional area of the intake point inside the nose. Acting as a Starling's resistor, it plays a pivotal role in controlling the inspiratory airflow. Nasal valve compromise, better known as nasal valve dysfunction, can be suspected when the patient complains of inspiratory nasal obstruction after trauma or surgery. If the patient has a history highly suspicious of nasal valve compromise, thorough physical examinations are mandatory in order to find the exact epicenter. The deformed L-strut septum and/or upper lateral cartilage are mainly responsible for the static internal nasal valve compromise. Characteristic findings include pinching of the middle vault and an inverted V deformity. Widening the nasal valve area is the most preferred therapy to correct statically narrowed nasal valve compromise. External valve compromise, on the other hand, is dynamically collapsible in many cases as evident during respiration. Typical sign, therefore, includes an inward collapse of alar and/or lateral wall upon inhalation. Treatment strategy, in this particular case, usually involves a cartilage addition to the deficient lateral wall or alar in order to stablize and provide rigidity to the lateral wall and also resist inspiratory negative force. However, surgeons should not be confused by the collapse as it may merely reflect the collapsibility of the structure rather than a genuine epicenter of nasal obstruction. Cartilage graft with or without suturing is the best therapeutic measure for patients with either static or dynamic nasal valve compromise when tackling nasal obstruction. It also enhances the structural integrity of the nasal valve. This review focuses on the various surgical techniques used in repairing nasal valve compromise to increase patency and restore breathing with an emphasis on each specific indication.