Functional Rhinoplasty: The importance of the internal nasal valve

internal nasal valve

internal nasal valve

The internal nasal valve is an area within the nasal airway that governs the flow of inspired air. The internal nasal valve is constituted by the triangular intersection of the structures that form its border.  These borders include the bottom portion of the quadrangular cartilage (nasal septum), the bottom edge of the upper lateral cartilage (which forms the nasal sidewall) and the floor of the nose, just inside the nasal sill.

Collapse of the internal nasal valve is a common finding in patients who present with nasal airway obstruction, for functional rhinoplasty. Although this can be a congenital condition, weakness of the internal nasal valve can also occur with nasal aging, following traumatic injury (including nasal fracture), and even more commonly as a result of prior nasal surgery.

Patients with internal valve collapse may note difficulty with nasal inspiration. On examination, the Cottle test (which manually opens the internal nasal valve) will be positive. Correction of internal valve collapse must be addressed during both cosmetic and functional rhinoplasty. Some patients with internal valve collapse may benefit from a short course (3 months) of nasal steroid treatments. However, true organic valve collapse requires surgical correction. Placement of  matchstick-sized pieces of cartilage between the upper lateral cartilage and septum (aka spreader grafts) is one of the most effective means of correcting internal valve collapse. Spreader grafts are usually harvested from the excess pieces of cartilage within the nose that are commonly removed during nasal surgery.


*photos on this post are not actual patients of Dr. Brenner.

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