What is Nasal Valve Insufficiency?

Nasal valves are the structures in the nose that regulate air flow. There are external and internal nasal valves. The external nasal valve is located in the nasal vestibule formed by the legs of the lower lateral nasal cartilage and the base of the nose. The internal nasal valve consists of the lower end of the upper lateral nasal cartilage, the nasal septum (middle part of the nose), the anterior end of the lower turbinate (nasal meatus), and the nasal lateral wall. It is located inside the nasal entrance at a distance of 1.5-2 cm. Normally, there is an angle of 10-15 degrees between the upper lateral nasal cartilage and the nasal septum, called the valve angle. The valve angle is part of the valve and the most important area of nasal resistance where airflow is regulated. Just 1 degree of narrowing here causes a 4 mm² narrowing in the nasal valve area. The cross-sectional area of the internal nasal valve is between 55 and 83 mm². Narrowing of the valve angle or reduction of the valve area (Nasal Valve Insufficiency) causes difficulty in breathing through the nose. Nasal valve failure is the third most common cause of nasal congestion in adults.

Causes of Nasal Valve Insufficiency?

The most common cause of nasal valve failure and collapse of the nasal side walls is rhinoplasty (nose aesthetics) surgery. It has been observed that the nasal valve narrows in 25% of those who had rhinoplasty surgery. Therefore, in rhinoplasty surgery, it should not be forgotten that the nose is not only an aesthetic but also a functional organ. Traumas, congenital weak cartilage and soft tissues, aging, facial paralysis,and cleft lip are other causes of nasal valve insufficiency.

What kind of Complaints Does Nasal Valve Insufficiency Cause?

Nasal congestion, sleeping with an open mouth, snoring; Generally, nasal congestion increases, and effort capacity decreases during exertion. Sleeping with the mouth open causes  a feeling of dryness and sticking in the throat, especially in the morning. Sleep quality is adversely affected and people often wake up with a feeling of fatigue.

How Is Nasal Valve Insufficiency Diagnosed?

In patients with nasal valve insufficiency, the structure of the nose is generally narrow. When the person with valve insufficiency breathes deeply through the nose, the sidewalls of the nose tend to collapse inward. The cottle maneuver is one of the methods that helps us to diagnose NVC. In this test, the cheek is pulled out (to the side and up) and the patient keeps breathing normally. If breathing is relieved, the test’s results is positive. Apart from nasal valve insuffiency , other causes of nasal obstruction should also be investigated. For this, the nasal septum is examined by opening the nose wings a little by an instrument called a nasal speculum. Also, endoscopic examination is performed to examine the posterior part of the septum, nasal concha, and the areas where the sinus canals open into the nose. In the endoscopic examination, an intranasal evaluation is performed with a 2.7 or 4 mm thick instrument called a nasal endoscope, with a tiny camera and light on the tip. Both examination methods are painless and take a short time. Usually, there are no tests required for the diagnosis of nasal valve insufficiency , but the narrowing of the nasal valve can be revealed objectively with Acoustic Rhinometry and Rhinomanometry tests. If there are other nasal problems such as septum deviation, hypertrophy of the nasal concha, sinusitis, and polyps accompanying nasal valve failure, sinus tomography can be performed for evaluation of the nose and surrounding sinus structures in detail.

Treatment of Nasal Valve Insufficiency 

A permanent solution requires surgery. The surgery aims to widen the narrowed valve angle. There are special graft and suture techniques that help to open the valve area. In graft techniques, cartilage is taken from the nasal septum or ear, shaped, and placed inside the nose to expand the valve area. Stitches are placed for the fixation. For a temporary solution, outside nasal strips or an inside silicone dilator  (Nozovent) can be used at night.
In nasal valve insufficiency cases, it is important not to focus only on the valve angle. At the same time, if there are problems in the nasal septum, concha, and other nasal structures, it is necessary to correct them all in the same session. Valve surgery can be performed under general anesthesia, local anesthesia, or sedation. Previously it was mostly performed with local anesthesia, but due to the comfort of the patient and the surgeon general anesthesia is preferred nowadays.
Before the operation, it is evaluated with the anesthesiology examination and some preoperative tests whether there is an obstacle or risky situation for the surgery.
The technique I developed for the surgical treatment of nasal valve insufficiency shortens the operation time, increases the success rate of the operation, and does not require stitches to fix the graft. This technique gives 90% successful results. The technique I developed has been published in Laryngoscope magazine, which is known for its international reputation

You can find my article from the link below

Islam A, Arslan N, Felek SA, Celik H, Demirci M, Oguz H. Reconstruction of the internal nasal valve: modified splay graft technique with endonasal approach. Laryngoscope. 2008 Oct;118(10):1739-43. doi:10.1097/MLG.0b013e31817f1913

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