FUNCTIONAL-EFFECTS OF ALAR CARTILAGE MALPOSITION

Nasal airway obstruction is frequently synonymous with septal deviatio n or inferior turbinate hypertrophy. Less readily appreciated is the f act that the mobile lateral nasal wall caudal to the bony arch can obs truct the airway, particularly at the internal or external nasal valve s. External valvular incompetence can result from postsurgical or cong enital causes, among the most common of which is alar cartilage malpos ition. Twenty-seven patients with alar cartilage malposition in a seri es of 61 patients (44%) treated for airway obstruction from external n asal valvular incompetence comprise this report. Rhinomanometric data demonstrate an increase in total nasal airflow from 99 +/- 17 ml (mean +/- SEM) to 190 +/- 37 ml per 14 seconds after valvular correction. P atients in whom additional septal pathology was corrected nevertheless had no significant airflow improvement over patients with external va lvular reconstruction alone. Treatment principles of valvular incompet ence from alar cartilage malposition are given for primary and seconda ry rhinoplasty patients, among which is a composite conchal cartilage/ skin graft that can reconstruct a functioning lateral crus and replace a vestibular skin deficiency. Interestingly, alar cartilage relocatio n to correct the malposition also narrows the alar base, even when no alar wedge resection is performed.