What is a nasal valve?
The nasal valve refers to the narrowest segment of your nasal airway. There are two types of nasal valves - the internal nasal valve and the external nasal valve. The internal nasal valve consists of the front part of the upper septum, inferior turbinate, and upper lateral cartilage. The external nasal valve consists of the visible external part of the nostril, including the columella, the front part of the lower septum. Both the internal and external nasal valve problem can present as a chronic obstructive problem due to constant narrowing or dynamic obstructive problems due to a collapse during forceful breathing, for example, during exercise.
How do I know if I have a nasal valve problem?
Patients with nasal valve problems are chronic mouth breathers. Frequently they find themselves breathing through their mouth when they exercise.
Patients with nasal valve problems will have constant trouble breathing through their noses even with medical treatments like allergy medicines, or nasal spray. Some of these patients are heavy snorers because they cannot breathe through their noses when they are laying down to sleep.
Often times, these patients will experience improvement with Breathe-Right Strips. If this describes your history of nasal obstruction, you may have a nasal valve problem. Ultimately, a careful physical exam will confirm whether you have a nasal valve problem, and also determine what type of nasal valve problem you may have.
Rhee JS, Weaver EM, Park SS, et al. Clinical consensus statement: diagnosis and management of nasal valve compromise. Otolaryngol Head Neck Surg. 2010; 143(1): 48-59
Rhee JS, Poetker DM, Smith TL, et al. Nasal valve surgery improves disease-specific quality of life. Laryngoscope. 2005; 115(3):437-440
Does a nasal valve problem affect the appearance of the nose as well?
While the nasal valve problem does not always manifest in the appearance of the nose, there are some classic tell-tale appearances of the nose with a nasal valve problem.
Narrow, pointy, or pinched appearance are classic examples of patients with a nasal valve problem. Some crooked or asymmetric noses can have nasal valve problems. Others may have noticed that their nostril will collapse when they are breathing rapidly during exercise. While changing the appearance of the nose is not the objective of a nasal valve repair procedure, often times the appearance will also improve when the structural problem related to the nasal valve is corrected.
What are the causes of nasal valve problems?
While many patients are just born with a weak or limited nasal airway, others may acquire the problem over time. Events such as a broken nose, surgery involving the nose or sinus cavity can result in changes of the nose that can weaken or compromise the nasal valve areas. The natural aging process can affect nasal valve structures in several ways. The ligaments that hold the nasal cartilages together begin to weaken and stretch; bone around the nose resorbs (just like everywhere else in the body); and the cartilages themselves become more flaccid. See aging nose for details on what can be done about this process.
What is involved in the nasal valve repair procedure?
There are numerous surgical techniques to repair the nasal valve. The most commonly used strategy involves reinforcing the problematic nasal valve by introducing structural cartilage graft to strengthen the area.
Internal nasal valve problem:
After careful physical examination, the surgeon will determine which component of the internal nasal valve is the problem and employ the appropriate technique necessary to correct this. The spreader graft is one of the most commonly used techniques to correct an internal nasal valve problem. This technique will widen the angle of the internal nasal valve, and in the process can also straighten the crooked nose. Because precise placement is paramount to the success of this technique, Dr. Kim prefers to place spreader grafts under direct visualization through an open rhinoplasty approach. Frequently, Dr. Kim will utilize the flare suture technique at the same time with the spreader graft placement to further improve the outcome.
External nasal valve problem:
After careful physical examination, the surgeon will determine which component of the internal nasal valve is the problem and employ the appropriate technique necessary to correct this. The alar batten graft is one of the most commonly used techniques to strengthen the collapsing or weakened external nasal valve.
Spielmann PM, White PS, Hussain SS. Surgical techniques for the treatment of nasal valve collapse: a systemic review. Laryngoscope. 2009; 119(7): 1281-1290
Simon P, Sidle Douglas. Augmenting the nasal airway: Beyond septoplasty. Am J Rhinol Allergy 26, 326-331, 2012
How long does it take to recover from a nasal valve repair procedure?
This depends on the extent of the procedure. If the patient’s problem can be adequately addressed via the endonasal approach (“closed”) nasal valve repair procedure, patients will often return to work in a few days. Most patients do not require any nasal packing and should be able to breathe through their nose after a few days. Sutures are placed inside the nose and they are dissolving sutures.
If the patient requires a septoplasty with more extensive nasal surgery, such as the functional open rhinoplasty, they will have a small incision under the nose and possibly a splint outside the nose. The small suture under the nose and the splint outside the nose will be removed at day 7 after the surgery. The patient may resume desk activities a few days after the surgery, but outdoor activity or exertion should be avoided for about 10 days. Aerobic exercises may be resumed after 2 weeks with intensity increased gradually thereafter.
Double board-certified Facial Plastic Surgeon Dr. Sang W. Kim at Natural Face Clinics specialize in aesthetic enhancement of the face, head, and neck, exclusively. Patients come to see us from the Syracuse metropolitan area and Central New York area including Ithaca, and Rochester. At Natural Face Clinics, we specialize in restoring the youthful neck contour, tired appearance of the brows and eyes, and skin laxity. We offer customized treatment, both surgical and non-surgical, including facelift, eyelid surgery (blepharoplasty), nose surgery (rhinoplasty), brow lift, neck lift, and skin resurfacing. Find out more by scheduling your personal consultation today.