The incompetent external nasal valve: pathophysiology and treatment in primary and secondary rhinoplasty.

The size of any nasal airway depends not only on the width and contour of the septal partition and inferior turbinates but also on the position and stability of the lateral nasal wall under the pressure changes that occur during the dynamic process of ventilation. Thus any congenital or acquired weakness of the upper or lower lateral cartilages or their investing soft tissues may profoundly affect the ability to draw adequate volumes of air through the nose. Sixty-one surgical patients treated for incompetence of the external nasal valves (comprising the cutaneous and skeletal support of the mobile alar walls) are the subjects of this paper. Rhinomanometric data on 16 patients with "pure" external valvular incompetence showed a twofold increase in total mean nasal airflow following valvular reconstruction with septal cartilage or bone grafts or with composite conchal cartilage-skin grafts for patients with associated vestibular skin deficiencies. Seven patients with combined external valvular and septal pathology derived most of their postoperative airflow improvement from correction of the valvular defect. The external nasal valve may be a substantial cause of nasal airway obstruction in some patients; its pathophysiology and treatment are discussed in primary and secondary rhinoplasty.