Surgical management of nasal alar rim and valve collapse

Abstract

Introduction Nasal valve collapse can provoke sleep-related breathing disorders in adults. Congenital and acquired alar rim collapse necessitates surgical treatment. The purpose of the present communication is to share our experience with the procedures for reconstruction of the external nasal valve after septoplasty on the occasion of nasal septal deviation, reconstruction and rhinoplasty. Materials and methods During the period from 2000 till 2010, we treated 33 patients with bilateral alar rim collapse and 4 patients with unilateral one. Fifteen patients presented with a congenital pathology. Rhinoplasty was previously performed in 18 patients but septoplasty in four ones. There were nasal septum deformities in 32 patients. The following surgical techniques were applied: lateral rhinopexy, autologous cartilage transplantation, modified lateral rhinopexy, fixation of the cranial end of alar cartilage to the caudal end of triangular cartilages, and suturing techniques as well. In two cases, percutaneous fixation of the alar rims was carried out. Results The immediate postoperative results were satisfactory. A better aesthetics and an improved breathing function could be achieved in all the patients. The comparative evaluation of the surgical techniques identified the advantages of the external rhinoplasty approach, lateral rhinopexy, cartilage transplantation and suturing techniques. However, there patients complained of relapse two months after operation. Conclusion Based on our experience and the data from the world literature available the conclusion can be drawn that nasal valve and alar rim collapse represent a serious challenge for contemporary rhinosurgery. An individualized surgical approach to the single patients is obligatory. The aggressive surgical methods seem to be more effective. Acknowledgements P. Nedev M. Milkov R. Benchev D. Vicheva.