Internal Valve Stenosis Rhinoplasty Workup

  • Author: David Núñez-Fernández, MD, PhD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Jan 21, 2010
 

Imaging Studies

  • CT scanning of paranasal sinuses
    • Coronal views provide good information on the patency of the nasal valve, especially the area under the nasal dorsum (nasal valve area), which is sometimes difficult to visualize.
    • This study is expensive and should not be considered a substitute for a comprehensive physical examination.
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Other Tests

  • Rhinomanometry
    • This helps evaluate the airflow resistance offered by each cavity.
    • It is a useful test, but it does not provide information about the location of the obstruction.
  • Acoustic rhinometry
    • This method is relatively new. It was introduced in the late 1980s.
    • Results provide information about the cross-sectional area of the nose.
    • It can provide information about the position of the obstruction.
    • Results from the anterior portion of the nose are more accurate than results from the posterior, making this test particularly suitable for evaluating the valve.
    • Acoustic rhinometry is important to evaluate the symmetry of the areas because the cross-sectional area varies depending on the size of the nose.
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Diagnostic Procedures

  • The nasal valve is better explored without instruments because tools can open the valve and produce the false impression that the area is normal. A headlight and an endoscope are the only necessary instruments to examine the nasal valve. In many male patients (and some females), the vibrissae are thick, making direct visualization of the area difficult. If this occurs, one option is to trim them until the valve can be visualized.
  • The Cottle test is a good method to examine the vestibular portion of the nasal valve. It consists of pulling the nasolabial fold upward and laterally and asking the patient if breathing is better (see the image below). An affirmative answer implies that a collapse of the valve is present on that side. A negative answer means the cause of the obstruction is elsewhere in the nose. A false-positive result can occur in patients with collapse of the nasal ala. False-negative results are observed in patients with scars or webs in the valve that prevent it from opening. False-negative results also occur in those with narrowing of the pyriform aperture secondary to congenital malformation or after an excessive narrowing of the nasal base with an osteotomy. The Cottle test is useful to evaluate nasal valve The Cottle test is useful to evaluate nasal valve stenosis. The cheek of the evaluated side is gently pulled laterally with 1 or 2 fingers, which opens the valve.
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Contributor Information and Disclosures
Author

David Núñez-Fernández, MD, PhD  Assistant Professor of Otolaryngology (External Associate), Department of Otolaryngology-Head and Neck Surgery, Charles University Faculty of Medicine of Hradec Králové, Czech Republic

David Núñez-Fernández, MD, PhD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, Mexican Academy of Cosmetic Surgery, Mexican Society of Otolaryngology, Head and Neck Surgery, and Mexican Society of Rhinology and Facial Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Jan Vokurka, MD, PhD  Head, Associate Professor, Department of Otolaryngology, Charles University Hospital of Hradec Králové, Czech Republic

Disclosure: Nothing to disclose.

Gloria Fernández-Muñoz, MD  Head, Otolaryngology Clinic, Centro Medico Echegaray, Mexico

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel G Becker, MD  Assistant Professor, Department of Otorhinolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Pennsylvania School of Medicine

Daniel G Becker, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American College of Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dean Toriumi, MD  Associate Professor, Department of Otolaryngology, University of Illinois Medical Center

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

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Rhinoplasty for internal valve stenosis. Normal internal nasal valve anatomy. Notice the relationship between the septum, upper lateral cartilage, pyriform aperture, and inferior turbinate.
Rhinoplasty for internal valve stenosis. External nasal valve stenosis. The nasal rim is collapsed because of an extremely thick columella.
Rhinoplasty for internal valve stenosis. Internal nasal valve stenosis. Notice the collapse of the area between the septum and the left upper lateral cartilage. Also notice the decrease of cross-dimensional area due to the deviated anterior septum.
Rhinoplasty for internal valve stenosis. Septal causes of valvular stenosis, from left to right, are (1) a thickened septum, (2) deflection of the septum, and (3) caudal deviation with an inferior spur.
Rhinoplasty for internal valve stenosis. Upper lateral cartilage (ULC) causes of valvular stenosis, from left to right, are (1) excessive returning, (2) thickened ULC, (3) twisted ULC, and (4) deflected ULC.
Rhinoplasty for internal valve stenosis. Mucocutaneous causes of valvular stenosis, from left to right, are (1) synechia, (2) stricture, and (3) edema of mucosa.
Rhinoplasty for internal valve stenosis. Iatrogenic causes of valvular stenosis. Absence or excessive trimming of the ULC.
The Cottle test is useful to evaluate nasal valve stenosis. The cheek of the evaluated side is gently pulled laterally with 1 or 2 fingers, which opens the valve.
 
 
 
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