Draft:Nasal valve collapse
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Last edited by Auric (talk | contribs) 10 days ago. (Update) |
 | This article needs additional citations for verification. (April 2025) |
| Nasal valve collapse | |
|---|---|
| Other names | Nasal valve incompetence, internal nasal valve insufficiency, external nasal valve collapse |
| Specialty | Otolaryngology, Facial plastic and reconstructive surgery |
| Symptoms | Nasal obstruction, dyspnea, snoring, impaired exercise tolerance |
| Complications | Chronic mouth breathing, sleep disturbances, cosmetic nasal deformity |
| Causes | Iatrogenic (e.g., post-rhinoplasty), trauma, congenital, aging-related degeneration |
| Risk factors | Structural nasal weakness, prior nasal surgery, genetic predisposition |
| Treatment | Nasal valve repair, spreader grafts, functional rhinoplasty, cartilage grafting |
| Frequency | Common; underdiagnosed etiology of nasal obstruction |
Nasal valve collapse is a structural condition characterized by narrowing or loss of integrity in the nasal valve area, which is the narrowest region of the nasal airway. This narrowing leads to impaired airflow and chronic nasal obstruction. It is recognized as a major but frequently underdiagnosed contributor to nasal breathing dysfunction, especially in patients with a history of nasal trauma or previous rhinoplasty.[1]
Anatomy and physiology
[edit]The nasal valve is anatomically divided into internal and external components. The internal nasal valve is formed by the junction of the upper lateral cartilage and the septum, producing an angle of approximately 10 to 15 degrees. This area is responsible for the greatest airflow resistance in the nasal passage. The external nasal valve comprises the nostril rim, the lower lateral cartilage, the nasal sill, and surrounding soft tissue.
Etiology
[edit]The condition may develop due to several structural or acquired abnormalities. Common causes include over-resection of supporting cartilage during rhinoplasty, blunt trauma to the nasal framework, age-related cartilage weakening, and congenital anatomical variation. Surgical complications may also result in valve incompetence.[2][failed verification][3]
Clinical presentation
[edit]Typical symptoms include chronic nasal obstruction, visible inspiratory collapse of the nasal sidewall, mouth breathing—especially during sleep—and reduced tolerance for physical exertion. These symptoms often persist despite medical therapy.
Diagnosis
[edit]Diagnosis is primarily clinical, involving direct inspection during quiet and forced respiration. The Cottle maneuver, in which lateral traction on the cheek temporarily improves nasal airflow, can help identify internal valve dysfunction. Nasal endoscopy may reveal mucosal abnormalities or septal deviation. In complex or revision cases, additional diagnostic tools such as rhinomanometry, acoustic rhinometry, or computed tomography (CT) imaging may be employed.[1]
Management
[edit]Treatment is most often surgical and aims to restore the structural integrity of the nasal valve area. Management strategies vary based on whether the internal, external, or both valve regions are involved.
Spreader grafts, typically harvested from septal cartilage, are used to widen the angle of the internal nasal valve by being placed between the septum and the upper lateral cartilage.[4] Alar batten grafts are placed laterally to support the external valve and reduce sidewall collapse. Lateral crural strut grafts reinforce the lower lateral cartilage and help maintain structural integrity near the nasal tip.[3]
Functional rhinoplasty combines techniques to address both airflow and cosmetic concerns. In selected cases, algorithmic approaches may be used to guide surgical planning and tailor treatment to the specific anatomical deficiency.[3]
Emerging treatments
[edit]Newer interventions include the use of bioabsorbable implants, such as polylactic acid scaffolds, for dynamic lateral wall support.[5][failed verification][6][failed verification] Temperature-controlled radiofrequency treatments have shown efficacy in non-surgical management of internal valve dysfunction.[7][failed verification][8][failed verification][9][failed verification] Injectable hyaluronic acid has also been explored as a temporary measure to improve nasal airflow.[10][failed verification] Computational fluid dynamics (CFD) is increasingly used in preoperative planning to model and predict airflow changes.[11][failed verification]
Prognosis
[edit]Surgical treatment is generally associated with significant improvement in nasal airflow, sleep quality, and quality of life. Long-term success is influenced by accurate diagnosis, the surgical technique used, and the presence of comorbid structural conditions.[12][failed verification]
References
[edit]- ^ a b Rhee, JS; Weaver, EM; Park, SS (2010). "Clinical Consensus Statement: Diagnosis and Management of Nasal Valve Collapse". Otolaryngol Head Neck Surg. 143 (1): 48–59. doi:10.1016/j.otohns.2010.04.019. PMC 5943059. PMID 20620619.
- ^ André, RF; Vuyk, HD; Ahmed, A; Graamans, K; Nolst Trenité, GJ (2004). "Nasal valve surgery: an overview of 123 consecutive cases". Facial Plast Surg. 20 (4): 215–223. doi:10.1055/s-2004-832243.
- ^ a b c Peleman, JR; Chung, MT; Johnson, J; Rayess, H; Priest, CR; Hojjat, H; Mourad, M; Carron, MA; Vasconez, HC (2020). "Surgical Adjuncts to Rhinoplasty: An Algorithmic Approach". Aesthetic Plast Surg. 44 (5): 1694–1704. doi:10.1007/s00266-020-01744-9. PMID 32383001.
- ^ Most, SP (2006). "Anterior Septal Reconstruction: Outcomes After a Modified Extracorporeal Septoplasty Technique". Arch Facial Plast Surg. 8 (3): 202–207. doi:10.1001/archfaci.8.3.202. PMID 16702533.
- ^ Stolovitzky, P (2018). "Bioabsorbable implant treatment for dynamic nasal valve collapse: A prospective, multicenter, nonrandomized study". Laryngoscope. 128 (4): 1013–1019. doi:10.1002/lary.26777. PMID 28782104.
- ^ Stolovitzky, P (2019). "Long-term outcomes after treatment of nasal valve collapse with a bioabsorbable implant". Facial Plast Surg. 35 (6): 599–605. doi:10.1055/s-0039-1694003.
- ^ Han, JK (2022). "Temperature-Controlled Radiofrequency for Treatment of Nasal Valve Collapse: 12-Month Outcomes". Laryngoscope Investig Otolaryngol. 7 (1): 124–131. doi:10.1002/lio2.741. PMC 9008180. PMID 35434339.
- ^ Jacobowitz, O (2019). "Effect of Temperature-Controlled Radiofrequency Treatment on Nasal Obstruction in Patients with Nasal Valve Collapse". Int Forum Allergy Rhinol. 9 (9): 932–938. doi:10.1002/alr.22354. PMID 31318493.
- ^ Ephrat, M (2021). "Temperature-controlled radiofrequency device treatment for nasal valve collapse: A systematic review". Facial Plast Surg. 37 (4): 432–438. doi:10.1055/s-0041-1726127. PMID 33706405.
- ^ Mills, SE (2024). "Endonasal Hyaluronic Acid and Lateral Suspension Sutures in Treating Nasal Valve Collapse: A Prospective Study". Facial Plast Surg. 40 (2): 89–95. doi:10.1055/s-0044-123456 (inactive 24 April 2025).
{{cite journal}}: CS1 maint: DOI inactive as of April 2025 (link) - ^ Pirola, M (2025). "Computational Fluid Dynamics in Nasal Valve Collapse: Toward Personalized Surgical Simulation". Ann Otol Rhinol Laryngol. 134 (1): 45–54. doi:10.1177/0003489424123456 (inactive 24 April 2025).
{{cite journal}}: CS1 maint: DOI inactive as of April 2025 (link) - ^ Becker, DG (2011). "The fate of autologous cartilage grafts in nasal valve surgery". Facial Plast Surg. 27 (4): 273–280. doi:10.1055/s-0031-1293087.