Reynolds M B, Gourdin F W
Section of Dermatology, Medical College of Georgia, Augusta, USA.
Dermatol Surg. 1998 Sep;24(9):1011-7. doi: 10.1111/j.1524-4725.1998.tb04295.x.
The nasal valve is the narrowest part of the nasal vestibule and is an important regulator of airflow. Nasal valve insufficiency (NVI), which can be caused by nasal surgery, results in nasal stuffiness, or resistance to airflow on inspiration. This entity has not been well described in the dermatologic surgery literature.
To study nasal valve insufficiency in 100 consecutive patients who had Mohs surgery for skin cancer of the nose, review the literature, and report methods for prevention of this complication.
One hundred consecutive nasal Mohs surgery cases were studied retrospectively. Symptomatic patients were evaluated based on several parameters to determine causative and exacerbating factors, and possible methods of prevention. The pertinent literature was reviewed.
Out of 100 patients, 92 responded--38 (41.3%) of whom were determined to be "at risk" for NVI based on the anatomic location of their defects. Out of those 38, five (13.2%) had new onset nasal stuffiness. An additional three of the 38 (7.9%) reported an exacerbation of prior nasal obstructive symptoms. Healing by secondary intention, bulky flaps, inadequate cartilaginous support, inappropriate choice of flap, mucosal scarring, and sacrifice of nasalis and levator labii superioris alaeque nasi fibers were identified as contributors to postoperative NVI.
NVI is a relatively common complication of Mohs surgery and reconstruction of the lower third of the nose. Treatment is difficult, but prevention is possible in many instances. Therefore, surgeons should be well aware of this entity and techniques that may aid in its prevention.
鼻瓣膜是鼻前庭最狭窄的部分，是气流的重要调节器。鼻瓣膜功能不全（NVI）可由鼻部手术引起，导致鼻阻塞或吸气时气流阻力增加。这一情况在皮肤科手术文献中尚未得到充分描述。
研究100例连续接受Mohs手术治疗鼻部皮肤癌患者的鼻瓣膜功能不全情况，回顾相关文献，并报告预防该并发症的方法。
对100例连续的鼻部Mohs手术病例进行回顾性研究。对有症状的患者根据多个参数进行评估，以确定病因和加重因素以及可能的预防方法。查阅相关文献。
100例患者中，92例作出回应——其中38例（41.3%）根据其缺损的解剖位置被确定为有NVI“风险”。在这38例中，5例（13.2%）出现新发鼻阻塞。38例中的另外3例（7.9%）报告先前的鼻阻塞症状加重。二期愈合、臃肿皮瓣、软骨支持不足、皮瓣选择不当、黏膜瘢痕形成以及鼻肌和提上唇鼻翼肌纤维的牺牲被确定为术后NVI的促成因素。
NVI是Mohs手术及鼻下部三分之一重建的相对常见并发症。治疗困难，但在许多情况下可以预防。因此，外科医生应充分了解这一情况以及可能有助于预防的技术。
