Surgery for Nasal Valve Stenosis

Abstract

Nasal valve is now regarded slit-like opening between the caudal end of the upper lateral cartilage and the septum. Because of wider nasal valve angle than Caucasians, we have fewer chances to experience patients with stenotic nasal valve. However, with careful history taking and Cottle test, we can recognize patients with nasal obstruction due to nasal valve stenosis. They require surgical correction. Surgical intervention was directed toward reconstruction of normal anatomic relationships between upper-and lower lateral cartilage and between the former and septal cartilage. This is usually achieved by widening the nasal valve angle and preventing collapsibility. There are two methods of approach to the nasal valve ; transnostril approach and open rhinoplasty.1) Transnostril approach Retracting the ala by means of the blunt retractor, the lower border of the upper lateral cartilage is identified. Incision of the skin parallet to the lower end of the upper lateral cartilage at lmm distance (intercartilagenous incision). The incision is continued just beyond the angle of the valve. Dissection of the caudal end of the cartilage is performed by elevating the mucoperichondrium with sharp, slightly-curved scissors. A strip of cartilage is resected from the caudal end of the upper lateral cartilage.2) open rhinoplasty approach Notched transcolumellar incision at the level of the midcolumella. This incision is connected to bilateral columellar marginal incisions that is usually placed lmm behind the rim of the columella. By using scissors, the skin overlying the medial crura is dissected. The flap is carefully elevated up from the underlying medial crura. Then the flap is elevated off of the surface of the lower lateral cartilage. Decortication is accomplished with dissection of soft tissue form the region of the anterior septal angle. Caudal margin of the upper lateral cartilage is resected or fixed on the lower lateral cartilage.