ABSTRACT
The development of nasal obstruction after rhinoplasty is associated with significant
patient dissatisfaction. Correction of nasal obstruction requires a thorough evaluation
to determine the anatomic epicenter of obstruction. The offending structure can usually be traced to abnormalities in
the internal nasal valve, intervalve area, or the external nasal valve and may be
static or dynamic. Surgical correction of the internal nasal valve using spreader
grafts, flaring sutures, and butterfly grafts has been shown to increase the cross-sectional
area of this nasal valve, improving nasal airflow and patient satisfaction. External
valve dysfunction from cicatricial stenosis may be addressed with local flaps; however,
larger stenoses may require composite grafts. Alar base malposition can be addressed
by repositioning of the alar base with local island flaps. Intervalve dysfunction
involves the important area between the external and internal valves, under the supra-alar
crease, and is the most common site of obstruction. Its correction often involves
alar batten grafts and reconstruction of the lateral crura. Inferior turbinate hypertrophy
and concha bullosa may be addressed as adjunctive therapy to increase nasal airflow.
This article on nasal obstruction after rhinoplasty emphasizes the precise anatomic
diagnosis and describes successful methods used to correct the dysfunction.
KEYWORDS
Revision rhinoplasty - functional rhinoplasty - nasal obstruction
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Stephen S ParkM.D.
Division of Facial Plastic Surgery, Department of Otolaryngology–Head & Neck Surgery,
University of Virginia Medical Center
PO Box 800713, Charlottesville, VA 22908-0713
eMail: ssp8a@virginia.edu