Dr. Moustafa Mourad explains in detail what a nasal valve collapse is and the exact surgery that is done to fix it.

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Anatomy of the nose. The nose is made up of two bones that form the upper one-third of the nose and five cartilages that make up the lower two-thirds of the nose. The lower cartilages are comprised of two upper cartilages known as the upper lateral cartilages and two lower cartilages known as the lower lateral cartilages. In the midline of the nose is a septal cartilage that separates the left and right sides of the nose. The internal nasal valve is comprised of the area between the septum and the upper lateral cartilages. The external nasal valve is comprised of the lower lateral cartilages in the nasal tip.

Difficulty in breathing can occur due to what is referred to as nasal valve collapse. When the cartilages of the middle or lower third of the nose are weakened or narrowed, they can collapse during inspiration. This narrowing can occur or be worsened as you breathe through the nose. In very severe cases, the nostrils can pinch on themselves causing a complete obstruction.

In order to correct weakening or narrowing of the nasal valve, a portion of the nasal septum is removed. It is important to maintain what is called an L-strut, an L-shaped portion of the septum that is at least 1 cm in width. A rectangular portion of the septum is removed. Grafts are fashioned from the septum that are later used to reconstruct the nasal valve areas. The internal nasal valves are strengthened through what are known as spreader grafts. The external nasal valves are strengthened through what are known as strut grafts.

Spreader graphs are placed between the upper lateral cartilages and nasal septum, effectively spreading or widening the nasal valve area, allowing for improved nasal airflow. Strut grafts are placed on the undersurface of the nasal tip cartilages, reinforcing them, allowing them to bend less during nasal inspiration. Combining spreader grafts with strut grafts can effectively make the nose stronger and less prone to pinching during nasal inspiration.

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