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Abstract
Shape and function are virtually inseparable in septorhinoplasty. The ENV is bounded laterally by the lateral crus of the LLC with the surrounding fibrofatty soft tissue and medially by the columella and medial crus of the LLC. The INV is bounded laterally by the caudal border of the lateral crus of the ULC, till its attachment to the piriform aperture, and medially by the caudal septum. The nasal valve area represents the narrowest segment of the nasal airway. It ,s CSA is about 20–60 mm2. The nasal valve angle is the angle between the lateral crus of the ULC and the caudal septum. This angle ranges between 10° and 15°.
The INV regulates nasal airflow through inward and outward mobility during breathing. The nasal valve area acts like accelerator, turbulizer and diffuser of the inspired air. The nasal valve area is considered to be responsible for up to half of the airflow resistance of the entire respiratory tract.
Thorough history and careful patient examination are important in diagnosis and management of nasal valves disorders.
Nasal valves disorders may be either separate ENV or INV disorders, or combined disorders. These disorders may be anatomical disorders (stenosis) or functional ones (collapse), or combined stenosis and collapse. Intramural or extramural factors may be the cause of these disorders.
Different investigations are available to assess different nasal valves components as, various CT scan techniques, rhinomanometry, acoustic rhinometry, the three-dimensional virtual endoscopic technique, the video-endoscopy and digital image analysis. Although multiple investigations are available, no single reliable one to diagnose nasal valve disorders, and multiple investigations are usually needed.
Numerous surgical and non-surgical methods are described for correction of nasal valves disorders. Surgical interference is used in correction of vestibular stenosis, correction of caudal septal deviation, correction of obstruction secondary to inferior turbinate hypertrophy, and correction of INV disorders. The non-surgical methods are used for strengthening the nasal valves and the attached muscles, and for dilatation of the nasal valves.
Rhinoplastic surgeries are common iatrogenic cause of nasal valves disorders. So in patients undergoing these surgeries some precautions are needed to avoid postoperative nasal valves dysfunction.