Nasal Valve Collapse (Nasal Vestibular Stenosis)
The complex relationship between nasal structure and function is reflected in the multitude of abnormalities leading to nasal obstruction. For instance, a nose that has an abnormally large inside airway will give the patient the sense of nasal obstruction, only in part due to build-up of nasal crusting. For normal breathing to be present, a certain resistance to nasal airflow is required. Too little resistance due to an abnormally large nasal space will lead to obstruction just like too much resistance will. Therefore, nasal surgeons are extremely careful not to remove but to modify internal nasal structures such as septum and turbinates. The concept of nasal valve obstruction (a.k.a. nasal stenosis) has evolved over the last 25 years. Today, rhinoplasty surgeons and otolaryngologists distinguish between the internal nasal valve and external nasal valve.
Internal Nasal Valve
The internal nasal valve is a naturally occurring narrow area of the inner nose. The turbinates, nasal septum, upper lateral cartilages and their junction points all contribute to the shape and patency of the internal nasal valve. Depending on the structural abnormality, repair may include septoplasty, turbinoplasty and ‘spreader grafts’. Spreader grafts are fashioned from cartilage and act as wedges between the septum and the upper lateral cartilages thereby enlarging the area of the valve.
External Nasal Valve
Nose surgeons recognized that the resilience of the nasal sidewall plays a role for nasal breathing. Airflow into the nose during inspiration leads to negative pressure inside which pulls the nasal side walls in. If these side walls are weak, this can lead to a total collapse of the nose with complete obstruction. The popularity of Breathe Right nasal strips is in part due to the fact that the spring of these devices increases support of the nasal sidewall and opens the nasal valve. Although shown to be effective, most people do not want to wear these devices on a daily basis. Some patients pull their cheeks outwards in order to demonstrate how they can improve nasal breathing.
Reasons for Nasal Vestibular Stenosis
One of the most common causes for nasal valve impairment is prior rhinoplasty surgery. Findings during surgical repair commonly include absent or severely weakened lateral crura of the lower lateral cartilages. In addition, aging changes of the nose can include drooping of the tip and weakening of the nasal side walls. As a congenital abnormality, the nose may always have had tight nasal valves.
Repair of Nasal Valve Collapse
One of the most effective techniques used for repair of vestibular stenosis includes the use of batten grafts. Batten grafts are usually fashioned from the patient's own cartilage; nasal septum, ears or rib are possible sites of origin. The accurately carved strips are placed strategically to improve support of the nasal side wall. The impact of these batten grafts on the nasal appearance is sometimes very subtle and most commonly desired. Repair of nasal vestibular stenosis is commonly covered by health insurance as part of a functional rhinoplasty.
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