THE INCOMPETENT EXTERNAL NASAL VALVE - PATHOPHYSIOLOGY AND TREATMENT IN PRIMARY AND SECONDARY RHINOPLASTY

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.