Upper lateral cartilage suspension over dorsal grafts: a treatment for internal nasal valve dynamic incompetence

The internal nasal valve incompetence (INVI) can be divided into (1) static: when the articulation between the dorsal edge of the upper lateral cartilages and the dorsal edge of the septum forms an angle less than 10 to 15 degrees and (2) dynamic: when the upper lateral cartilages collapse attracted by the negative pressure during inspiration. To correct both the static and dynamic components in severe cases of INVI, the authors propose a surgical technique consisting of upper lateral cartilages suspension over dorsal grafts; the dorsal margins of the two upper lateral cartilages are pulled dorsally and sutured together over the dorsal edge of the septum and over the dorsal-spreader grafts. The post-operative results of 12 patients affected by INVI with severe nasal obstruction were evaluated. Such a technique, which utilizes both the widening and the suspension effects, is particularly useful in the most severe cases of dynamic INVI.