| Nasal valve stenosis commonly presents as a post-operative complication of rhinoplasty. Various techniques have been reported to correct nasal valve stenosis through the use of methods that support the nasal valve with rib graft,' cartilage,' or onlay cartilage graft.' Sheen' popularized the use of a spreader graft, which is inserted between the upper lateral cartilage (ULC) and the septum. The spreader graft lateralizes the superior segment of the ULC and is effective when this portion has been medially displaced.
Frequently, the collapse involves the entire caudal aspect of the junction of the ULC and the lower lateral cartilage, and a spreader graft is not sufficient. Other methods have been proposed that involve cartilage grafts to strengthen the lateral nasal wall and flaring suture to augment the nasal valve repair with spreader graft. However, these techniques have not proved to be uniformly successful. Paniello reported an external approach through the transconjunctival incision to suspend the ULC with permanent sutures. We modified this approach with bilateral infraorbital incisions by using multiple suspension sutures to elevate the ULC superolaterally and to alleviate the nasal valve stenosis. This is a preliminary study of this technique and the results are repeated herein.
The nasal valve was first described by Mink" in 1903, and its anatomy was de-fined by Bridger. as the flow-limitingsegment of the nasal airway that was located at the triangular aperture between the ULC and the septum. The angle between the ULC and the septum ranges from 10° to 15°. This angle is maintained by the relationships among the nasal septum, the lower lateral cartilage, and the attachments of the facial muscles.
The nasal valve functions in a manner similar to that of the Starling resistor and is influenced by Bernoulli forces. Both the nose and the Starling resistor consist of a semirigid tube with a flexible segment. In the nose, as the inspired air pressure exceeds a critical value. the flexible segment collapses. resulting in nasal obstruction. Thus, some degree of strength and rigidity of the lateral component of the nasal valve is necessary to prevent its collapse during inspiration. Surgical procedures that weaken the lateral nasal wall at the junction of the ULC and the lower lateral cartilage may result in a loss of rigidity of the lateral nasal wall.
The concept of improving intranasal air space by opening the nasal valve has been well documented in sports. The use of an external nasal dilator (Breathe Right; CNS Inc, Chanhassen, Minn) by athletes can be seen at al-most every sporting event. The proposed mechanism of such an external nasal dilator in healthy subjects and in subjects with structural or mucosal abnormalities is to increase the minimum cross-sectional area of the nasal cavity and the area of the nasal valve. previous page next page>> |
Aesthetics and Aging A New Paradigm
