Complications of Rhinoplasty - Page 13

Nasal Valve Collapse

The internal nasal valve is bounded by the caudal margin of the upper lateral cartilage and the septum. The external nasal valve refers to the area delineated by the cutaneous and skeletal support of the mobile alar wall, anterior to the internal nasal valve 3 0 Excessive narrowness or flaccidity in either of these locations may cause nasal obstruction. Weakness at either of these locations may result in collapse with the nega tive pressure of inspiration, resulting in nasal airway obstruction. Nasal valve collapse is seen most often as a sequela of overresection of lateral crura or middle vault collapse. Over-aggressive resection of the lateral crura and the subsequent postoperative soft tissue contraction frequently leads to nasal valve compromise. Failure to maintain proper middle vault support may lead to inferomedial collapse of the upper lateral cartilages, with internal nasal valve compromise.

Treatment of internal nasal valve collapse may include the use of spreader grafts. Spreader grafts act as a spacer between the upper lateral cartilage and septum, correcting an overly narrow middle vault and internal nasal valve, or preventing excessive narrowing when undertaking a rhinoplasty in the high-risk patient.

Careful preoperative analysis should determine the need for other supportive and reconstructive maneuvers, such as conchal cartilage grafts to restore support to a collapsed lat eral nasal wall. Alar batten grafts, typically of curved septal or auricular cartilage, placed to support the alar rim can correct internal or external nasal valve collapse (Fig. 39-6).

Figure 39-6 Alar batten grafts may be used to treat nasal valve collapse. (From Toriumi DM, Becker DG. Rhinoplasty Dissection Manual. Philadelphia : Lippincott Williams & Wilkins; 1999. With permission.)

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