Vestibular stenosis nasal valve collapse

When we think about the airflow through our respiratory system, it doesn’t take much thought to realize that airflow resistance is highly important for good pulmonary function. Our nose is where more than half of this resistance is from. The anterior portion of the nose is where most of the resistance occurs. This area is known as the nasal valve, and it acts as a flow limiter.

nasal valves

This diagram pinpoints where both the external and internal nasal valves are located inside the nose.

The external nasal valve is constructed by the nasal floor, the nasal wall, and by the middle of the nose in the front called the columella. The nasalis muscle expands the external valve area during inhalation.

The internal nasal valve is what we normally mean when we are referring to the area called the “nasal valve”. The internal nasal valve is where most of the flow resistance is created. It is in the area between the nasal septum and the mobile side cartilage of the nose. When air comes in the narrow valve, a negative pressure is made and the valve tends to collapse. After inhale is the exhale, where the negative pressure releases and the passage opens to its original position. Nasal valve collapse can be dynamic, fixed or both.

deviated septum

Causes of vestibular stenosis (nasal valve collapse)

The causes of nasal valve collapse can be aging, iatrogenic causes, congenital or secondary after trauma. After reduction rhinoplasty, the structure of the nose can be weakened and/or could cause a decreased cross-sectional portion of the nasal valve. A deviated septum can narrow the valve as well.

Temporary vestibular stenosis (nasal valve collapse) repair

No single approach has been universally corrective when dealing with nasal valve collapse — often this condition requires multiple solutions.

The simplest solution is the use of prosthetic splints such as springs taped to the outside of the nose and wire or plastic baskets for the inside of the nose. This will provide clear breathing during periods of sleep or exercise, however, they are not an acceptable solution for most social situations.

Nasal collapse surgery

The most common choice of correction is to surgically alter the internal nasal valve. This requires the use of a spreader graft put between the upper lateral cartilage and the septum. This corrects the lower margin of the upper lateral cartilage and thus will widen the middle nasal vault.

nasal_collapse

This “Before & After” photo shows one of Dr. Bennett’s patients who underwent a correction of the bilateral internal valve collapse.

Those with severe external or internal valve collapse may need further correctional procedures to complement the results of the spreader grafts.

Many structural cartilage grafts have been promoted to build up the weakened lateral nasal wall. The alar batten graft is commonly used. Alar batten grafts are grafts used to fortify the nasal airway and prevent collapse. The name alar batten comes from the word alar (the cartilaginous flap on the outer side of each nostril) and batten (which is a nautical term describing: a thin narrow strip of lumber used especially to seal or reinforce a joint. Ex: “Batten down the hatches.”)

Normally alar batten grafts are inserted in the pockets just up from the lower lateral cartilages. They are placed in a subcutaneous pocket. Alar batten grafts can be made up of septal, costal, or conchal cartilage. However, conchal cartilage or ear cartilage, is often shaped in a curved manner making them ideal choice for patients with significant collapse.

Many other procedures and techniques have been described to correct this ailment. It has been said that each of these techniques, while having their merits, have limitations as well. Nasal valve collapse can be complex and requires the practitioner to be well versed in several procedures in order to be successful in its repair.

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