A Clinical Challenge: Nasal valve compromise can be a dicey problem, panelists say

“Unfortunately, I see a lot of this in my practice,” Dr. Toriumi said. “It’s a combination of repair with lateral wall structural grafting. But I also have to replace tissue. I have to put vestibular lining back.”

Also challenging are cases of previous intercartilaginous incisions that haven’t healed properly, leaving scarring.Once the scar tissue is removed, “you’re left with raw mucosal surface, and in order to correct that, you need to bring in tissue,” he said.

William Shockley, MD, chief of facial plastic and reconstructive surgery at the University of North Carolina in Chapel Hill, discussed the tension nose, in which the dorsum is too high, and the saddle nose, in which the dorsum is too low. Both can be linked to nasal obstruction.

Neither problem has been well studied, so there is not much data on the effect that surgeries have had on patients with nasal obstruction.

But Dr. Shockley said that they generally yield good results. “For the tension nose,” he said, “if you can lower the dorsum, widen the cartilaginous vault and, secondarily, deproject the nasal tip, they typically get improvement in their cross-sectional nasal airway, and usually an improvement in internal and external nasal valve function.”

Similarly, if the saddle nose is corrected by elevating the dorsum, supporting the middle vault, reprojecting the tip and correcting any tip ptosis, there is generally improved internal nasal valve function and, in some patients, better external function, too, Dr. Shockley said.