Surgical Treatment of Dynamic Nasal Collapse

Abstract

Nasal obstruction is a prevalent issue that significantly impacts patient quality of life and contributes to a large-scale financial burden. Internal or external nasal valve collapse may play a role in nasal obstruction, with varying etiologies. Surgical correction of nasal valve collapse is indicated when septal and/or turbinate surgery alone are not sufficient in correcting the nasal obstruction. The choice of how to address nasal valve repair depends on presenting findings, associated aesthetic concerns, particularly of the nasal tip, patient anatomy, and surgeon preference. This article provides a methodical approach to the diagnosis of nasal valve collapse, indications for repair, and provides detailed explanation of the operative techniques used to address nasal valve collapse, while also discussing the advantages and disadvantages of each approach.

Management of Lateral Wall Insufficiency

“…Spreader grafts are positioned between the septum and ULC unilaterally or bilaterally, and can be placed via an endonasal or open rhinoplasty approach. 29 Alar batten grafts are a workhorse for the treatment of LWI and can address both INV and ENV collapse. They can be placed via an endonasal approach or during traditional open rhinoplasty.…”

“…The articulated ARG (AARG) is a modification of the ARG with integration to the tip framework, providing increased stability and minimal risk of graft migration. 29 In addition, this technique can be a powerful tool to correct alar retraction. An open rhinoplasty approach is used, followed by dissection and release of the lateral crus.…”

Internal Nasal Valve Modification via Correction of High Dorsal Deviation Using a Modified Mattress Suture Technique

“…The internal nasal valve (INV) is the narrowest part of the nasal airway, and its borders are the caudal margin of the upper lateral cartilage, the nasal septum, and the anterior border of the inferior turbinate [ 2 ]. The normal angle of the INV is 10 to 15 degrees in Caucasians [ 3 ]. Since the INV is the narrowest region of the nose, this area has the greatest influence on airflow resistance [ 4 ].…”

“…Nasal obstruction due to nasal valve collapse can be static, dynamic, or both [ 5 ]. Dynamic collapse can occur due to Bernoulli’s principle when the lateral nasal wall has insufficient support [ 3 ]. Stenotic narrowing or stenosis of the INV is caused by anatomical problems, such as septal deviation or turbinate hypertrophy [ 5 ].…”