Rhinoplasty Dr Bashar Bizrah Article on: PostRhinoplasty Probleins and Revision Surgery Part 7: Valve collapse

23. Valve collapse:

The nasal valve is a triangular shaped opening defined by caudal margin of the upper lateral cartilage, nasal septum and the floor of the pyriform aperture. (Fig. 13 – 17 A)

Nasal valve collapse leads to nasal obstruction.

Causes:

1. Excessive trimming of caudal upper lateral cartilage.
2. Excessive trimming of cephalic lower lateral cartilage. (Fig. 13 – 15B)
3. Excessive trimming of anterior ends on inferior turbinates.
4. Excessive infracture of nasal bones.
5. Medial collapse of the upper lateral cartilage.
6. Too far on the lateral extension of the intercartilagenous excision, that disturbs the lateral attachment of the lower lateral cartilage to the pyriform aperture and overlying skin and muscle.

Prevention:

1. Starting the intercartilagenous incision at one cm, lateral to the midline then carried on medially to the transfixion incision.
2. Preserve at least eight mm of vertical lateral crus.
3. Limited trimming of the caudal upper lateral cartilage which is confined to curvature and scoll.

Treatment:

Alar Batten graft and upper lateral cartilage augmentation as indicated.

24. Problems related to the loss of tip support:

Causes:

1. Rhinoplasty routine incisions:
   Disturbed tip cartilages attachment to both caudal septum and upper lateral cartilages.
2. Excessive trimming of cephalic lateral crus.
3. Excessive trimming of caudal septum and superior septal angle.
4. Not using compensatory measures to support the tip (new dome creation, suture fixation, scoring, columellar strut, tip graft with septocolumellar suture).
5. Using blind endonasal transcartilagenous techniques.
6. Poor closure of transfixion incision.

Results:

1. Bulbous dropped tip. (Figs. 13 – 18,21,20B)
2. Hanging columella.
3. Wide nares due to flaring of alar rim.

4. Acute nasolabial angle.
5. False pollybeak.

Treatment:

Alar delivery and consideration of new dome creation, suture fixation, scoring, columellar strut and tip graft with septocolumellar sutqre. Also the Bizrah modification of Goldman’s tip is recommended in these revised cases.

25. Impaired nasal airways:

Causes:

1. Uncorrected septal deviation.
2. Enlarged inferior turbinates.
3. Allergic rhinitis.
4. Valve collapse. (Fig. 13 – 15B)

Treatment:

1. Revision septoplasty with submucous diatherny or partial trimming of inferior
   turbinates.
2. Corticosteroid nasal spray and an antihistamine. The postrhinoplasty allergic reaction is usually transient and subsides in a few months.

26. Graft problems:

Complications of graft such as infection, absorption, floating, displacement and demarcation were fully discussed in the chapter on saddling and augmentation.