The nasal valve is an anatomical region that limits the passage of air inside the nose. It is actually composed of two parts, one external, corresponding in practice to the circumference of the nostrils and the alar cartilages of the nasal tip, and the other internal, consisting of the section where the septum joins the triangular cartilages of the lateral walls of the nose. Its function is to decrease the speed of the air breathed in, which would otherwise reach the lower airways (pharynx, larynx, bronchi and lungs) too soon without having been adequately humidified, warmed and cleansed by the nose. Malfunctioning of the nasal valve can decrease the airflow to varying degrees and was often not diagnosed in the past, as the septum and turbinates alone were held responsible for respiratory obstruction. This explains why many operations of septoplasty and surgical reduction of the turbinates failed to produce the desired results. Defects of the valve are in any case easy to detect by examination, as the lateral wall of the nose, due to its weakness, moves inward to a considerable degree during inspiration, obstructing the passage of air. In practice, the valve over-performs its function, no longer limiting the flow of air into the nasal cavities but blocking it almost completely.

The causes of nasal valve deficiencies can be congenital, traumatic or the result of previous surgical operations. Patients sometimes find relief, without identifying the exact reason for their impaired respiration, in the application to the nose of plasters of the kind commonly sold in pharmacies, which do nothing other than strengthen the nasal valve from the outside. The surgical procedures carried out in these cases pursue the same objective of reinforcement but from the inside with grafts of cartilage from the septum or auricular concha. In the case of revision rhinoplasty, spreader grafts, alar batten grafts or grafts for total reconstruction of the alar cartilages can be used.

Spreader grafts (shown in red) of cartilage from the nasal septum or auricular concha are placed on either side of the dorsal septum in order to expand the internal nasal valve and restore satisfactory respiration

Alar batten grafts (shown in red) are placed on the lateral cartilages of the nose in order to correct deficiencies of the external nasal valve.

The patient underwent two operations of septorhinoplasty some years earlier, which were followed by impaired respiration as well as pinching and drooping of the nasal tip. Examination of the patient revealed deficiency of the external nasal valve with collapse of the nasal wings, as well as pinching in the area of the tip.

The patient also suffered from polly beak deformity of the supratip area. The surgical correction of these defects involved grafts of cartilage from the concha to reconstruct the alar cartilages of the tip, which had been completely removed in the previous operation. A columellar strut graft was inserted into the tip to strengthen it and increase its degree of projection, thus preventing the possibility of subsequent collapse in the postoperative period.