Correction of Internal Nasal Valve Obstruction Induced by Posttraunmatic Scar Constriction: A Case Report

ABSTRACT

The borders of the internal nasal valve are defined by the caudal edge of the upper lateral cartilage supero-laterally, the cartilaginous septum medially, and the nostril floor inferiorly. It is the narrowest portion of the nasal airway and one of the primary regulator of nasal air flow. internal nasal valve collapse is a serious problem associated with prior nasal surgery, previous trauma, aging, or primary weakness of the upper lateral cartilage. We report a case of the internal nasal valve obstruction due to an uncommon mucocutaneous scarring. A 55-year-old male patient complained of headache, severe nocturnal snoring and unilateral nasal obstruction. He had a linear depressed 1.5cm in length scar on the nose dorsum, caused by a lacerated wound. The intranasal examination revealed a concentric narrowing of the left internal nasal valve area by mucocutaneous scar constriction and a left sided septal deviation, but inferior turbinate hypertrophy was not seen. After an open rhinoplasty incision, the nasal airway obstruction was relieved by scar release with the five flap Z-plasty, submucosal resection of deviated septal cartilage and unilateral spreader graft using autogenous septal cartilage. He was pleased with a significant relief of nasal obstructive symptoms. The cross- sectional size of the internal nasal valve area was maintained until postoperative 8 months. Correction of internal nasal valve obstruction must involve surgery on all the structures that make up the valve: septum, upper and lower lateral cartilage, intranasal mucosa, and the inferior turbinate.