Mb. Constantian, THE INCOMPETENT EXTERNAL NASAL VALVE - PATHOPHYSIOLOGY AND TREATMENT IN PRIMARY AND SECONDARY RHINOPLASTY, Plastic and reconstructive surgery, 93(5), 1994, pp. 919-931
The size of any nasal airway depends not only on the width and contour
of the septal partition and inferior turbinates but also on the posit
ion and stability of the lateral nasal wall under the pressure changes
that occur during the dynamic process of ventilation. Thus any congen
ital or acquired weakness of the upper or lower lateral cartilages or
their investing soft tissues may profoundly affect the ability to draw
adequate volumes of air through the nose. Sixty-one surgical patients
treated for incompetence of the external nasal valves (comprising the
cutaneous and skeletal support of the mobile alar walls) are the subj
ects of this paper. Rhinomanometric data on 16 patients with ''pure''
external valvular incompetence showed a twofold increase in total mean
nasal airflow following valvular reconstruction with septal cartilage
or bone grafts or with composite conchal cartilage-skin grafts for pa
tients with associated vestibular skin deficiencies. Seven patients wi
th combined external valvular and septal pathology derived most of the
ir postoperative airflow improvement from correction of the valvular d
efect. The external nasal valve may be a substantial cause of nasal ai
rway obstruction in some patients; its pathophysiology and treatment a
re discussed in primary and secondary rhinoplasty.