Nasal Valve Collapse and Treatment

Nostril Collapse - Alar Collapse

Nasal Valve Collapse and Treatment

Nose Wing and Nazal Valve Region


The nasal valve area between the nasal wings and the upper part of the nasal septum is considered to be the narrowest cross-sectional area within the nose. Narrowing of the nasal valve can cause severe nasal obstruction during normal or forced breathing in patients as the nasal side wall collapses.

Nasal valve definition -  Nasal valve collapse - Nostril collapse - Alar collapse - Treatment of nasal valve collapse - Treatment of alar collapse - Nasal valve collapse surgery - Repair of nasal valve collapse - Nasal valve collapse operation

The nasal valve region is located just behind the nostrils and has the highest airway resistance. According to the "Poiseuille Law", which is a physics theory, in a single air passage with different amount of air flow passing increases or decreases by the fourth force of radius ratios. This means that when you switch from a passage with a radius of 2 mm to a passage with a radius of 1 mm, the air flow is reduced by 16 times. Accordingly, slight decreases and increases in the valve region, which is the narrowest airway region of the nose, can cause serious changes in airflow.

The nasal valve region is the area immediately after the nostrils and can be briefly described as follows:

- Outside, lower edge of upper lateral cartilage
- Internal septum
- There is a bone priform aperture at the bottom.

The nasal valve region can be divided into two as internal nasal valve and external nasal valve.

Internal Nasal Valve


The area between the upper edge of the nasal septum and the upper lateral cartilage. This is the region that causes severe nasal congestion when narrowed. The internal nasal valve is the area between the upper part of the nasal septum and the lower end of the upper lateral cartilage.  The main valve region responsible for airway resistance is the internal nasal valve. In some people, although these regions are not narrow; it may be loose enough to collapse with the nose wings during breathing.

External Nasal Valve


The area between the outer legs of the cartilages and the outer and vestibular soft tissue areas. The outer nasal valve is 1-1.5 cm in front of the inner nasal valve region and consists of connective tissue on the lateral leg of the alar cartilage and around the sesamoid cartilages. 

Nasal Valve Mechanism



Nasal valve definition -  Nasal valve collaps - Nostril collapse, Alar collapse - Treatment of nasal valve collapse - Treatment of alar collapse - Nasal valve collapse surgery - Repair of nasal valve collapse - Nasal valve collapse operation
Nasal valve zones (internal and external nasal valve) may act as Starling resistors (foldable tubing attached to rigid tubing). As the air flow rate increases, transmural pressure increases, which causes collapse and a drop in airflow. This can be a mechanism for preventing unheated and moisture-free air from reaching the lower airways in large volumes. In people with acquired or congenital external valve constriction, this mechanism works under very low transmural pressure and leads to premature collapse and difficulty with nasal breathing.

What Is the Nasal Valve Collapse (Nostril Collapse - Alar Collapse)?


Some causes of nasal obstruction may require treatment with rhinoplasty techniques. A cause of nasal obstruction is the collapse of the nose wing. Nasal swelling occurs due to structural constriction of the nose and dynamically collapsing of the weak nasal side walls during inhalation. The nose is narrowness and weakness in the lower inner part of the nose wings, the narrowest part of the respiratory tract.

Nasal valve definition -  Nasal valve collapse - Nostril collapse - Alar collapse - Treatment of nasal valve collapse - Treatment of alar collapse - Nasal valve collapse surgery - Repair of nasal valve collapse - Nasal valve collapse operation

The cartilages that form the nasal wings can collapse in breathing or normal posture due to the weakness of the cartilage support tissue from trauma, surgical procedure, infection or birth. Nasal wings collapse when breathing is called alar collapse.

Nostril Collapse - Weak Nasal Valve Area

Treatment of  Nasal Valve Collapse


Nasal valve definition -  Nasal valve collapse - Nostril collapse - Alar collapse - Treatment of nasal valve collapse - Treatment of alar collapse - Nasal valve collapse surgery - Repair of nasal valve collapse - Nasal valve collapse operation


There are a number of surgical approaches available for the treatment of nasal valve collapse. Selecting the appropriate surgical intervention depends on the correct definition of the anatomical cause of the collapse. Alar batten grafts are particularly useful for nasal flap collapse, which is caused by a weak nasal wing due to cartilage. Nasal valve problems (in the treatment of alar collapse or nasal cavity collapse) placement of alar batten grafts, reversing the cartilages or placing the cartilaginous parts of each wing cartilage to be reversed by other wing cartilage, removing the cartilage with various suture techniques and expanding the nasal valve angle spreader surgical techniques such as placement of grafts can be used. The operation is performed for both aesthetic and functional reasons.
The most important ones as support cartilage of the nasal tip are the outer legs of cartilage or cartilage called alar cartilage and the lower part of the upper lateral cartilage. In patients with nasal valve collapse, "nasal valve surgery" may be required, including open technique nasal tip surgery, cartilaginous nasal cartilage and cartilage grafting to support nasal sidewalls.


On the above photo, cartilage graft was applied to the patient who had left nasal valve collapse during open technique rhinoplasty operation and the collapse of the nose wing was eliminated.


On the above photo, right sided nostril collapse is seen in paient who operated two times. Cartilage grafts was used during open technique rhinoplasty operation to fixing the weak nasal valve area. 

Nasal Valve Collapse and Treatment

On the above photo, right sided alar collapse is seen in paient who undergone rhinoplasty operation before at different clinic. Cartilage grafts was used to openning of nasal valve area andfixing the weak nasal valve area.


A complication that can be seen after rhinoplasty operation is "nasal valve collapse"


Especially in patients with thick skin and a wide nasal tip, as a result of the weakening of the alar cartilages under the nasal wings and the upper lateral cartilages in order to narrow the nasal tip, collapse in the nasal wings while breathing, collapse and narrowing in the nasal valve area may occur. When we surgeons perform rhinoplasty surgery, we actually have to think of function on both ends of a scale and aesthetics on the other. Particular care should be taken when narrowing the nasal tip, especially in patients with weak nasal wing cartilages and narrow nasal valve area. In the video above, a nasal video of a patient, who emerged about 14 years ago after rhinoplasty, complained of collapse of the nasal wings and nasal congestion while breathing, is seen. In order to obtain a thin and narrow nose, especially in order to protect the nasal functions, nasal aesthetics should be planned by taking into account the properties of the nasal skin and nasal cartilages.

Nose tip lifting and nasal valve surgery videos

You can see on the below two videos of nasal valve surgery and nose tip lifting operation.



Revision Nasal Surgery Is Sometimes Performed For Alar Collapse!


Alar collapse of the cartilage previously alar collapse or "alar collapse" may occur as a result. In this case, there may not be sufficient cartilage tissue to prepare the cartilage graft in the nose. Cartilage grafts can be prepared in the form of revision nose surgery, from the patient's ear claw or from its own rib tissue. With these cartilage grafts, loose, collapsed sections of the nose wings can be supported. This type of surgery requires surgical experienc and knowledge about nose anatomy.

Nasal valve definition -  Nasal valve collapse - Nostril collapse - Alar collapse - Treatment of nasal valve collapse - Treatment of alar collapse - Nasal valve collapse surgery - Repair of nasal valve collapse - Nasal valve collapse operation



Nasal valve definition -  Nasal valve collapse - Nostril collapse - Alar collapse - Treatment of nasal valve collapse - Treatment of alar collapse - Nasal valve collapse surgery - Repair of nasal valve collapse - Nasal valve collapse operation


Nasal valve definition -  Nasal valve collapse - Nostril collapse - Alar collapse - Treatment of nasal valve collapse - Treatment of alar collapse - Nasal valve collapse surgery - Repair of nasal valve collapse - Nasal valve collapse operation



Nasal valve definition -  Nasal valve collapse - Nostril collapse - Alar collapse - Treatment of nasal valve collapse - Treatment of alar collapse - Nasal valve collapse surgery - Repair of nasal valve collapse - Nasal valve collapse operation

Nasal valve definition -  Nasal valve collapse - Nostril collapse - Alar collapse - Treatment of nasal valve collapse - Treatment of alar collapse - Nasal valve collapse surgery - Repair of nasal valve collapse - Nasal valve collapse operation

Nasal valve definition -  Nasal valve collapse - Nostril collapse - Alar collapse - Treatment of nasal valve collapse - Treatment of alar collapse - Nasal valve collapse surgery - Repair of nasal valve collapse - Nasal valve collapse operation



Nasal valve definition -  Nasal valve collapse - Nostril collapse - Alar collapse - Treatment of nasal valve collapse - Treatment of alar collapse - Nasal valve collapse surgery - Repair of nasal valve collapse - Nasal valve collapse operation
 

Nasal valve definition -  Nasal valve collapse - Nostril collapse - Alar collapse - Treatment of nasal valve collapse - Treatment of alar collapse - Nasal valve collapse surgery - Repair of nasal valve collapse - Nasal valve collapse operation


Nasal valve Surgery - Revision Nose Operation


Open technique nasal valve operation was performed on the patient who had collapsed nasal wings and nasal obstruction during breathing, which occurred after a rhinoplasty operation 3 years ago in a different clinic. Bilateral spreader graft, bilateral alar batten graft, bilateral marginal rim graft were placed. You can see the images before and after the operation below.

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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
E-Mail: muratenoz@gmail.com
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47




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