ABSTRACT
One of the most difficult aspects in rhinoplasty is resolving and preventing functional compromise of the nasal valve area reliably. The nasal valves are crucial for the individual breathing competence of the nose. Structural and functional elements contribute to this complex system: the nasolabial angle, the configuration and stability of the alae, the function of the internal nasal valve, the anterior septum symmetrically separating the bilateral airways and giving structural and functional support to the alar cartilage complex and to their junction with the upper lateral cartilages, the scroll area. Subsequently, the open angle between septum and sidewalls is important for sufficient airflow as well as the position and function of the head of the turbinates. The clinical examination of these elements is described. Surgical techniques are more or less well known and demonstrated with patient examples and drawings: anterior septoplasty, reconstruction of tip and dorsum support by septal extension grafts and septal replacement, tip suspension and lateral crural sliding technique, spreader grafts and suture techniques, splay grafts, alar batten grafts, lateral crural extension grafts, and lateral alar suspension. The numerous literature is reviewed.
KEYWORDS
Nasal valves - functional aesthetic rhinoplasty - septoplasty - cartilage grafts - spreader grafts
REFERENCES
-
1
Ricci E, Palonta F, Preti G et al..
Role of nasal valve in the surgically corrected nasal respiratory obstruction: evaluation through rhinomanometry.
Am J Rhinol.
2001;
15
307-310
-
2
Eccles R.
Nasal airflow in health and disease.
Acta Otolaryngol.
2000;
120
580-595
-
3
Gubisch W.
Extracorporeal septoplasty for the markedly deviated septum.
Arch Facial Plast Surg.
2005;
7
218-226
-
4
Kasperbauer J L, Kern E B.
Nasal valve physiology. Implications in nasal surgery.
Otolaryngol Clin North Am.
1987;
20
699-719
-
5
Wexler D B, Davidson T M.
The nasal valve: a review of the anatomy, imaging, and physiology.
Am J Rhinol.
2004;
18
143-150
-
6
Cole P.
Biophysics of nasal airflow: a review.
Am J Rhinol.
2000;
14
245-249
-
7
Cole P.
The four components of the nasal valve.
Am J Rhinol.
2003;
17
107-110
-
8
Santiago-Diez de Bonilla J, McCaffrey T V, Kern E B.
The nasal valve: a rhinomanometric evaluation of maximum nasal inspiratory flow and pressure curves.
Ann Otol Rhinol Laryngol.
1986;
95(3 Pt 1)
229-232
-
9
Grutzenmacher S, Gunther M, Robinson D M, Mlynski G, Beule A.
Investigations for the diagnostic recording of nasal wing collapse.
Laryngoscope.
2005;
115
1763-1767
-
10
Vidyasagar R, Friedman M, Ibrahim H, Bliznikas D, Joseph N J.
Inspiratory and fixed nasal valve collapse: clinical and rhinometric assessment.
Am J Rhinol.
2005;
19
370-374
-
11
Urquhart A C, Bersalona F.
Septoplasty: correcting the nasal valve.
Laryngoscope.
1997;
107
537-539
-
12
Boccieri A.
Subtotal reconstruction of the nasal septum using a conchal reshaped graft.
Ann Plast Surg.
2004;
53
118-125
-
13
Pirila T, Tikanto J.
Unilateral and bilateral effects of nasal septum surgery demonstrated with acoustic rhinometry, rhinomanometry, and subjective assessment.
Am J Rhinol.
2001;
15
127-133
-
14
Roithmann R, Cole P, Chapnik J, Barreto S M, Szalai J P, Zamel N.
Acoustic rhinometry, rhinomanometry, and the sensation of nasal patency: a correlative study.
J Otolaryngol.
1994;
23
454-458
-
15
Adamson P, Smith O, Cole P.
The effect of cosmetic rhinoplasty on nasal patency.
Laryngoscope.
1990;
100
357-359
-
16
Grymer L F.
Reduction rhinoplasty and nasal patency: change in the cross-sectional area of the nose evaluated by acoustic rhinometry.
Laryngoscope.
1995;
105(4 Pt 1)
429-431
-
17
Roithmann R, Chapnik J, Zamel N, Barreto S M, Cole P.
Acoustic rhinometric assessment of the nasal valve.
Am J Rhinol.
1997;
11
379-385
-
18
Miman M C, Deliktas H, Ozturan O, Toplu Y, Akarcay M.
Internal nasal valve: revisited with objective facts.
Otolaryngol Head Neck Surg.
2006;
134
41-47
-
19
Fayman M S, Potgieter E.
Nasal middle vault support: a new technique.
Aesthetic Plast Surg.
2004;
28
375-380
discussion 381-382
-
20
Ozturan O, Miman M C, Kizilay A.
Bending of the upper lateral cartilages for nasal valve collapse.
Arch Facial Plast Surg.
2002;
4
258-261
-
21
Meyer R, Jovanovic B, Derder S.
All about nasal valve collapse.
Aesthetic Plast Surg.
1996;
20
141-151
-
22
Park S S.
The flaring suture to augment the repair of the dysfunctional nasal valve.
Plast Reconstr Surg.
1998;
101
1120-1122
-
23
Schlosser R J, Park S S.
Functional nasal surgery.
Otolaryngol Clin North Am.
1999;
32
37-51
-
24
Schlosser R J, Park S S.
Surgery for the dysfunctional nasal valve. Cadaveric analysis and clinical outcomes.
Arch Facial Plast Surg.
1999;
1
105-110
-
25
Sciuto S, Bernardeschi D.
Upper lateral cartilage suspension over dorsal grafts: a treatment for internal nasal valve dynamic incompetence.
Facial Plast Surg.
1999;
15
309-316
-
26
Hurst W B.
Internal nasal implant to correct nasal valve obstruction.
J Laryngol Otol.
1978;
92
47-50
-
27
Andre R F, Paun S H, Vuyk H D.
Endonasal spreader graft placement as treatment for internal nasal valve insufficiency: no need to divide the upper lateral cartilages from the septum.
Arch Facial Plast Surg.
2004;
6
36-40
-
28
Rohrich R J, Hollier L H.
Use of spreader grafts in the external approach to rhinoplasty.
Clin Plast Surg.
1996;
23
255-262
-
29
Constantinides M S, Adamson P A, Cole P.
The long-term effects of open cosmetic septorhinoplasty on nasal air flow.
Arch Otolaryngol Head Neck Surg.
1996;
122
41-45
-
30
Khosh M M, Jen A, Honrado C, Pearlmann S J.
Nasal valve reconstruction: experience in 53 consecutive patients.
Arch Facial Plast Surg.
2004;
6
167-171
-
31
Boccieri A.
Mini spreader grafts: a new technique associated with reshaping of the nasal tip.
Plast Reconstr Surg.
2005;
116
1525-1534
-
32
Toriumi D M, Josen J, Weinberger M, Tardy Jr M D.
Use of alar batten grafts for correction of nasal valve collapse.
Arch Otolaryngol Head Neck Surg.
1997;
123
802-808
-
33
Millman B.
Alar batten grafting for management of the collapsed nasal valve.
Laryngoscope.
2002;
112
574-579
-
34
Becker D G, Becker S S.
Treatment of nasal obstruction from nasal valve collapse with alar batten grafts.
J Long Term Eff Med Implants.
2003;
13
259-269
-
35
Constantian M B.
The incompetent external nasal valve: pathophysiology and treatment in primary and secondary rhinoplasty.
Plast Reconstr Surg.
1994;
93
919-931
discussion 932-933
-
36
Armengot M, Perez A, Izquierdo J, Campos A, Basterra J.
Upper lateral cartilage transposition in the surgical management of nasal valve incompetence.
Acta Otorrinolaringol Esp.
2001;
52
373-378
-
37
Troell R J, Powell N B, Riley R W, Li K K.
Evaluation of a new procedure for nasal alar rim and valve collapse: nasal alar rim reconstruction.
Otolaryngol Head Neck Surg.
2000;
122
204-211
-
38
Kalan A, Kenyon G S, Seemungal T A.
Treatment of external nasal valve (alar rim) collapse with an alar strut.
J Laryngol Otol.
2001;
115
788-791
-
39
Rohrich R J, Raniere Jr J, Ha R Y.
The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty.
Plast Reconstr Surg.
2002;
109
2495-2505
discussion 2506-2508
-
40
Ochi J W, deWerd D L.
Surgery for bilateral nasal valvular collapse.
Rhinology.
1988;
26
105-110
-
41
Dyer II W K, Yune M E.
Structural grafting in rhinoplasty.
Facial Plast Surg.
1997;
13
269-277
-
42
Ishida L C, Ishida J, Henrique Ishida L, Passos A P, Vieira J C, Ferreira M C.
Total reconstruction of the alar cartilages with a partially split septal cartilage graft.
Ann Plast Surg.
2000;
45
481-484
-
43
Gassner H G, Remington W J, Sherris D A.
Quantitative study of nasal tip support and the effect of reconstructive rhinoplasty.
Arch Facial Plast Surg.
2001;
3
178-184
-
44
Ghidini A, Dallari S, Marchioni D.
Surgery of the nasal columella in external valve collapse.
Ann Otol Rhinol Laryngol.
2002;
111
701-703
-
45
O'Halloran L R.
The lateral crural J-flap repair of nasal valve collapse.
Otolaryngol Head Neck Surg.
2003;
128
640-649
-
46
Paniello R C.
Nasal valve suspension. An effective treatment for nasal valve collapse.
Arch Otolaryngol Head Neck Surg.
1996;
122
1342-1346
-
47
Lee D S, Glasgold A I.
Correction of nasal valve stenosis with lateral suture suspension.
Arch Facial Plast Surg.
2001;
3
237-240
-
48
Friedman M, Ibrahim H, Syed Z.
Nasal valve suspension: an improved, simplified technique for nasal valve collapse.
Laryngoscope.
2003;
113
381-385
-
49
Friedman M, Ibrahim H, Lee G, Joseph N J.
A simplified technique for airway correction at the nasal valve area.
Otolaryngol Head Neck Surg.
2004;
131
519-524
-
50
Capone R B, Sykes J M.
The effect of rhytidectomy on the nasal valve.
Arch Facial Plast Surg.
2005;
7
45-50
-
51
Pontell J, Slavit D H, Kern E B.
The role of outfracture in correcting post-rhinoplasty nasal obstruction.
Ear Nose Throat J.
1998;
77
106-108
111-112
-
52
Croce G, Croce A, Neri G, Bianchedi M, Moretti A, Sacilotto C.
The history of nasal valve surgery.
Acta Otorhinolaryngol Ital.
1996;
16
189-201
Dr. med
Helmut Fischer
Klinik für Plastische Gesichtschirurgie, Zentrum Plastische Chirurgie/Marienhospital
Boeheimstrasse 37, 70199 Stuttgart, Deutschland
