Surgical approaches to abnormalities of the nasal valve.

A systematic surgical approach to nasal valve abnormalities depends on adequate and precise exposure of the abnormality to be corrected and is facilitated by the use of magnification. Small anatomic disturbances in the region of the nasal valve can produce significant airway obstruction by narrowing the nasal valve angle. Normally, this angle between the caudal end of the upper lateral cartilage and the nasal septum is from 10 to 15 degree. In all patients with nasal airway obstruction, a meticulous clinical evaluation of the nasal valve is required. Nasal valve abnormalities can produce symptoms due to an already increased collapsibility of the nasal valve; therefore surgical intervention is directed toward reconstruction of normal anatomic relationships, usually by widening the nasal valve angle and preventing either extreme of rigidity or collapsibility. Appropriate and delicate handling of the intercartilaginous aponeurosis between the upper lateral (roof) cartilage and the lower lateral (lobular or alar) cartilage with prevention of excessive scar tissue formation usually can be achieved by dissection on the upper lateral cartilage. The surgical plane is beneath the overlying musculature and neurovascular layers. By preserving the mucocutaneous lining and by accurate suturing of incisions, primary wound healing is facilitated. Clinical experience suggest that the application of these concepts benefits patients by preventing or treating abnormalities of the nasal valve. Eventually, longterm results with preoperative and postoperative physiologic testing (rhinomanometry), coupled with critical clinical re-evaluation, should allow adoption, rejection, or, more likely, modification of the principles offered by this contribution.