Nasal Valve Collapse and Treatment
What Are The Nasal Valves?
“Nasal valves” are areas in the nose that are narrow and cause difficulties in breathing. There are 2 nasal valves, an “internal” and an “external” nasal valve. The external nasal valve is the “nostril” of the nose and is made up of the ala, the round fleshy area on the sides of the nose. The ala is supported by cartilages located in the tip of the nose. The internal valve is located inside the nose and is the area between the nasal septum and the lowest portion of the upper lateral cartilage, which are cartilages located on the sides of the nose.
What Is A Nasal Valve Collapse?
There are many reasons for a nose to be congested and blocked. These include a deviated septum, enlargement of the natural tissues of the nose (also known as inferior turbinate hypertrophy), nasal polyps, and/or allergies. Another reason is lack of support on either side of the nose when you breathe inward. The “valves” should be strong and resist airflow when breathing in. Weak cartilages can cause the one or both valves of the nose to collapse inward causing blockages and nasal congestion. Sometimes the blockages can be a combination of all of the above-mentioned problems. A thorough evaluation by a specialist is needed to determine the cause of the blockage and the best treatment options for nasal valve collapse.
What Does Valve Collapse Look Like?
External valve collapse is apparent when you breathe inward and the nostril on one or both sides partially or completely closes on itself. Internal valve collapse may be less apparent on the outside but the upper middle portion of the nose on either side may narrow significantly on breathing in. Lifting up the skin around your nose, or using common aids like “Breathe-Rite” strips can alleviate blockages caused by the internal nasal valve, and can help in making the diagnosis. In addition, on the outside of your nose, you may see an upside-down triangle under the nasal bones which is an area of detachment of your upper cartilage. This is called an “inverted-V deformity” and is more common after a bump is removed or aggressive nasal surgery.
What Causes External Nasal Valve Collapse?
Weakness or upward orientation of the cartilages in the tip of your nose can cause the external valves to narrow with inspiration. If you have had a previous rhinoplasty, then the lower lateral cartilages may have been partially removed which will also weaken the external valves. Having widening of the skin and cartilage between your nostrils or a septum that you see deviated into one nostril will contribute to external valve narrowing.
What Causes Internal Nasal Valve Collapse?
For the internal valves, the upper lateral cartilages can be weak or very narrow causing collapse when breathing inward. A bump removal can cause the upper lateral cartilages to become disconnected from the midline septum and causing them to fall against the nasal septum. If the septum in the area of the internal valve deviates toward the valve then this will also cause valve narrowing.
Preparation For A Nasal Valve Procedure
You will meet with Dr. Mourad where he usually spends an hour going over everything related to your surgery. He will evaluate and make sure that he can specifically tailor a custom care plan to your exact needs. During the consultation, Dr. Mourad will determine the exact nature of your complaints and the exact causes. He may prescribe medications that will assist in your complaints. Once a tailored plan is made, Dr. Mourad and his staff will take you through all the necessary information needed to make sure that your surgery happens without issue. We take care of the details so that you can have the most enjoyable experience.
Dr. Mourad views treating his patients to be nothing short of a privilege and an honor and enjoys taking the time to get to know his patients and fully understand their issues. Dr. Mourad’s office provides a boutique experience that takes you out of the mindset of being at the doctor’s office. It is a warm, comfortable environment, providing a bespoke experience.
Will Medicines Fix Nasal Valve Collapse?
Medications sometimes help. Nasal steroids like Flonase may slightly decrease swelling inside the nose and just 1 millimeter of additional breathing room can feel amazing. Likewise, nasal saline rinses can sometimes make the nose feel more open by washing away mucous and cleaning the inside of the nose. If you have allergies, then antihistamines like Claritin and Zyrtec will decrease the tissue swelling. Decongestants like pseudoephedrine and those contained in Claritin-D will decrease swelling in the nose. Breathe-Rite strips can open the valves by pulling on the outside skin of the nose. Should over the counter and prescription medications not work then you may need a nasal valve surgery to improve your breathing.
What Is External Nasal Valve Surgery?
External valve surgery involves strengthening the cartilage and fleshy sides of the nostril with cartilage. This cartilage can be from your own septum, from your own rib, ears, or harvested from an organ donor. Using an open or closed nasal surgery, the cartilage is reshaped and reinforced to hold the external valves from collapsing.
What Is Internal Nasal Valve Surgery?
Cartilage can be placed either through an open or closed nasal surgery into the areas between the midline septum and upper lateral cartilages to hold the upper lateral cartilages away from the septum. This increases the area of the internal valves and as we discussed above, even one millimeter of improvement in the valve area can improve your breathing.
Are There Additional Ways To Fix The Valves?
If your tip is dropping then surgery to lift the tip can open both the internal and external valves. Straightening the septum or narrowing the skin and cartilage between the nose can increase the area of airflow and improve nasal valve function as well. Dr. Mourad has successfully used a technique that removes the lower edge of the upper lateral cartilage with an increase in the angle of the internal valve that he has found very effective.
What If Both Of My External And Internal Valves Are Collapsed?
You can repair the external and the internal valves on one or both sides at the same time. In fact, you can also have septoplasty, sinus surgery, and rhinoplasty during the same surgery. Dr. Mourad is an expert surgeon at all of the above procedures and will work with you to plan the right procedure to get you breathing better.
After Surgery and Recovery
Depending on your work, Dr. Mourad typically recommends taking a minimum of 3 days off before returning to work. He also discourages his patients from any heavy lifting. If you wear glasses, you may require some alterations if applicable. Dr. Mourad will provide you with pain medications, ointments, nasal sprays, all to help maximize your results. Dr. Mourad will then see you in visitations two weeks later, and then one month after that. Dr. Mourad enjoys the continued visitation of his patients and will see them in follow up for many years thereafter.
- Anesthesia: Depending on the type of anesthesia administered, patients may have a reaction. This is exceedingly rare, and it is important to discuss your personal risk with your anesthesiologist.
- Infection: In rare circumstances patients may develop an infection following nasal valve procedures. These are usually managed with intraoperative and postoperative antibiotics.
- Bleeding: Although rare, patients may have bleeding episodes following nasal surgery. Your surgeon will likely order blood work to make sure you are healthy enough to undergo the procedure. Your surgeon should also go over all medications and supplements that you take to minimizing bleeding risk.
- Need for secondary and revision surgeries: Depending on the complexity of the surgery, sometimes multiple surgeries are required to ensure the best aesthetic and functional outcomes.
- Scarring and Poor wound healing: Some patients with underlying medical conditions or more prone to poor wound healing and scarring. It is important to understand these risks prior to embarking on a treatment strategy.
- Local Reactions: Sometimes you may experience local reactions to the ointments, sutures, taping material, and nasal packing used during surgery and postoperatively. This is rarely seen, but may occur. If you have any allergies to certain materials or adhesives you should discuss with your surgeon.
- Changes in nasal sensation: Patients may experience altered sensations in their nose (pain or numbness). This is exceedingly rare, and if it occurs it is most often temporary.
- Persistent or Recurrent Nasal Airway Obstruction: Although the goal of surgery is to enhance breathing, sometimes patients may develop persistent or recurrent airway problems. This is rare, but oftentimes is due to poor wound healing or scarring (see above). This may require secondary surgeries to optimize outcomes.
- Continued need for medical therapies: If you have breathing complaints related to medical causes (e.g. allergies), then you may continue to require medical nasal therapies (e.g. nasal steroids and sprays).
- Nasal Septal Perforation: A hole in the septum may develop. Oftentimes these do not cause any problems. Other times however, they may cause crusting, bleeding, and breathing difficulties. These require secondary surgeries for repair.
Does Insurance Pay For Nasal Valve Surgery?
Yes! Because it is considered a “functional surgery” that will improve your quality of life, most insurances will pay for some or all of the costs for surgery, anesthesia and the facility fees. Our office will check your insurance benefits and let you know what they are before your office visit so there are no surprises. We will take care of the paperwork and dealing with your insurance company and will let you know what’s going on. Of course, cosmetic surgery is rarely if ever paid by insurance. Dr. Mourad is board certified in facial plastic surgery and otolaryngology and an expert nasal surgeon. If you think you have nasal valve collapse, please feel free to call our office.
Select Relevant Publications
Kadakia S, Mourad MW, and Ducic Y. Supraclavicular Flap Reconstruction of Cutaneous Defects Has Lower Complication Rate than Mucosal Defects. Journal of Reconstructive Microsurgery. 2017 May; 33(4):275-280. Link to Article.